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

Associations between alcohol intake and hospital contacts due to alcohol and unintentional injuries in 71,025 Danish adolescents - a prospective cohort study

Background

Alcohol is a leading risk factor to adolescent health. However, it is unclear how associations between alcohol intake and injuries are shaped. We investigated the dose-response relationship between alcohol intake and risk of hospital contacts due to alcohol and unintentional injuries in adolescents.

Methods

We conducted a prospective cohort study including 71,025 Danish students aged 15-24 years, followed up for five years from 2014 to 2019. The main outcome measures were hospital contacts due to alcohol and unintentional injuries (all injuries and head injuries), obtained from hospital registers.

Findings

Approximately 90% of males and females reported drinking alcohol, and the median intake among those was 11 drinks/week in males and 8 drinks/week in females. During five years of follow-up, 1.3% had an alcohol-attributable hospital contact, the majority of which were due to acute intoxication (70%). Alcohol-attributable hospital contacts were equally frequent in males and females and between age groups (15-17-year-olds vs 18-24-year-olds). Compared with never drinking, the adjusted incidence rate ratios for weekly intake of <7, 7-13, 14-20, 21-27, and >27 drinks/week were 1.70 (95% confidence interval 1.23-2.34), 1.77 (1.27-2.46), 1.91 (1.35-2.70), 2.34 (1.59-3.46), and 3.25 (2.27-4.64) for having an alcohol-attributable hospital contact within five years of follow-up. Restricting follow-up to one year more than doubled risk estimates. During the five years of follow-up, 27% incurred an unintentional injury. The most frequent types of injury were to the wrist or hand (27.6%), ankle or foot (25.2%), or head (12.4%). Injuries were more frequent among males (first-time incidence rate 110 per 1000 person-years) compared to females (82 per 1000 person-years), with no differences between age groups. Compared with never drinking, the adjusted incidence rate ratios for weekly intake of <7, 7-13, 14-20, 21-27, and >27 drinks were 1.09 (1.03-1.15), 1.14 (1.07-1.20), 1.25 (1.17-1.33), 1.38 (1.28-1.49), and 1.58 (1.47-1.69) for having a hospital contact for any type of unintentional injury within five years of follow-up. Results for the one-year follow-up period were comparable. Separate analysis for head injuries showed similar results as the analysis on all injuries. Results were generally similar in males and females.

Interpretation

Adolescents' drinking is associated with a higher risk of acute harm in terms of hospital contacts due to alcohol and unintentional injuries in a dose-response relationship. Thus, increased risk was apparent in those with low alcohol intake, suggesting a need for awareness of and initiatives to prevent youth drinking. Furthermore, initiatives should include a strengthened focus on people younger than 18 years.

Funding

This study was funded by the Tryg Foundation (ID: 153539) and The Helse Foundation (21-B-0359).

Health-Predictive Social-Environmental Stressors and Social Buffers Are Place Based: A Multilevel Example From San Bernardino Communities

Significant evidence demonstrates the powerful effects social determinants have on health-related perceptions, behaviors, and health outcomes. However, these factors are often studied out of context, despite the acknowledgement that social determinants of health are place based. This research aimed to demonstrate that health-related perceptions are dependent on where one lives. Via a community-based participatory study, participants were randomly selected from 3 residential regions varying distances from a freight railyard (nearest n = 300, middle n = 338, farthest n = 327), all mostly low-income, predominately Latino areas. Interview-administered surveys with adults were collected by bilingual trained community members (87% response) in English/Spanish. Adjusted-logistic regression models assessed residential region as a predictor of stressors (perceptions of community safety, community noise disturbance, health care access, food insecurity) and buffers (3 neighborhood cohesion variables), after adjusting for household income, race/ethnicity, gender, and age. Each region experienced a unique amalgam of stressors and buffers. In general, the region closest to the railyard experienced more stressors (odds ratio [OR] = 1.58; 95% CI 1.12-2.20) and less buffers (OR = 0.69; 95% CI 0.49-0.96) than the region furthest from the railyard. More than half of participants in each region reported 2 or more stressors and 2 or more buffers. In this seemingly homogenous study population, place remained important in spite of traditionally used socioeconomic factors, such as household income and race/ethnicity. Social determinants of health should be studied with regard to their environmental context, which will require interdisciplinary collaboration to improve multilevel research methods. Including the study of social buffers will also promote sustainable, positive change to reduce health disparities.

The influence of behavioural and socioeconomic factors on the community injury rates of adolescents assessed by the south Korean emergency medical services: an ecological approach

Background

Aim of this study is to determine if peer group risk behaviors and neighbourhood socioeconomic status (SES) would ecologically affect injury incidence according to place and gender among adolescents (aged 13–15) in South Korea.

Methods

Three variables from the Korea Youth Risk Behavior Survey (2014) were used to represent peer group risk behaviours; current alcohol consumption (cAlc), the experience of violence or bullying (VicVB), and having undergone education for injury prevention (Edu-IP). The Korea Census Data (2010) was used for neighborhood SES; the degree of urbanization, the proportion of high educational attainment, and the proportion of low residential environment. The nationwide and regional Incidence-Rates of Injury assessed by EMS (IRI-EMS) were calculated according to age and gender based on the number of injuries from EMS record (2014). A linear regression model was used to examine associations.

Results

The nationwide total and inside-school IRI-EMS were 623.8 and 139.3 per 100,000 population, respectively. The range of the regional IRI-EMS showed a maximum of about 4 times the difference from 345 to 1281 per 100,000 population depending on the region. The low residential environment had a significant effect on the increase of total IRI-EMS (β = 7.5, 95% CI 0.78–14.21). In the case of boys, the IRI-EMS inside-school was increased as the percentage of VicVB was higher (β = 17.0, 95% CI 1.09–32.91). In the case of girls, the IRI-EMS outside-school was increased in rural compared to urban location (β = 211.3, 95% CI 19.12–403.57).

Conclusion

The incidence rate of outside-school was higher than that of inside-school, and incidence rate of boys was higher than that of girls. Peer group risk behaviors were significant only in the injury of boys. Among the SES factors, rural area was a significant factor in girls, especially outside-school injury. Moreover, the rate of households not in an apartment was significant in all outside-school injury and outside-school injury of boys.

Our study suggests that among native South Korean adolescents, neighbourhood SES and peer group risk behavior have different effects depending on the injury context such as place of occurrence or gender.