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

Contextual and family factors associated with negative assessment of children's health

BACKGROUND

The health and well-being of children are intimately linked to their families' physical, emotional and social circumstances. Evaluation of children's health has most often been based on parental responses. This work investigates whether proxy health, family context and household factors are associated with child's poor health reported by parental figures.

METHODS

Data of 32,688 children of three age-strata (0-5; 6-11; 12-17 years) were obtained from a representative survey in Brazil in 2003. The analyses used generalized estimation equations to examine the association between having a bad health evaluation and the following factors grouped as: children/adolescents characteristics, history of child's health care use, proxy characteristics and family and household factors.

RESULTS

Over 60% of the questionnaires were answered by the child's mother, with no significant difference among age groups. The proportion of children who had their health rated as bad decreased with age and was greater among males in all age groups (9.7%; 7.5%; 6.7% vs. 6.8%; 6.6%; 6.3%). The final model shows that household income per capita is inversely related to child's bad health in all age groups. Additionally, parent/proxy bad self-rated health is strongly and directly associated with child's bad health and is not explained by measures of the child's health or by the proxy's lack of education or a family's low income. The number of medical visits by the child in past year is also inversely associated with bad health.

CONCLUSION

Results reinforce the importance of the household context to child's health and the association between parental figures and child health.

Road traffic crash circumstances and consequences among young unlicensed drivers: a Swedish cohort study on socioeconomic disparities

Background

Young car drivers run a higher risk of road traffic crash and injury not only because of their lack of experience but also because of their young age and their greater propensity for adopting unsafe driving practices. Also, low family socioeconomic position increases the risk of crash and of severe crash in particular. Whether this holds true for young unlicensed drivers as well is not known. Increasing attention is being drawn to the prevalence and practice of unlicensed driving among young people as an important contributor to road traffic fatalities.

Methods

This is a population-based cohort study linking Swedish national register data for a cohort of 1 616 621 individuals born between 1977 and 1991. Crash circumstances for first-time road traffic crash (RTC) were compared considering licensed and unlicensed drivers. The socioeconomic distribution of injury was assessed considering household socioeconomic position, social welfare benefits, and level of urbanicity of the living area. The main outcome measure is relative risk of RTC.

Results

RTCs involving unlicensed drivers were over-represented among male drivers, suspected impaired drivers, severe injuries, crashes occurring in higher speed limit areas, and in fair road conditions. Unlicensed drivers from families in a lower socioeconomic position showed increased relative risks for RTC in the range of 1.75 to 3.25. Those living in rural areas had an increased relative risk for a severe RTC of 3.29 (95% CI 2.47 - 4.39) compared to those living in metropolitan areas.

Conclusions

At the time of the crash, young unlicensed drivers display more risky driving practices than their licensed counterparts. Just as licensed drivers, unlicensed young people from low socioeconomic positions are over-represented in the most severe injury crashes. Whether the mechanisms lying behind those similarities compare between these groups remains to be determined.

Social determinants of child and adolescent traffic-related and intentional injuries: a multilevel study in Stockholm County

Several significant developmental and socialisation processes in the life of children and adolescents take place in the area where they live. The extent to which they can feel and be safe in this environment is an important component of the success of those processes. This study highlights the independent contribution of neighbourhood and individual-level demographic and socioeconomic attributes to child and adolescent injuries. All individuals between the ages of 7 and 16 years living in Stockholm County in January 1998 (n=184 545) were followed up for their injuries during a five-year period considering injuries sustained as a pedestrian/cyclist/motor-vehicle rider and intentional injuries (violence-related and self-inflicted). A series of two-level logistic regressions were conducted to examine the association between the occurrence of injuries and individual (compositional) characteristics nested into parish of residence as well as contextual characteristics. For children and adolescents living in Stockholm County, contextual socioeconomic and social attributes of their place of residence were significant for injuries sustained as motor-vehicle riders but not for those sustained as pedestrians/cyclists or those inflicted intentionally. In the latter case, only the highest concentration of social benefit recipients was associated with significantly higher odds ratios. This emphasises that each injury mechanism has its own socioeconomic and social pathway, where contextual and compositional factors come into play to varying degrees.

[Consequences for children involved in a road traffic accident: one year of observation and follow-up in the Rhone county]

Children aged 6 to 11 who have been injured in a traffic accident were observed over a one year period, in parallel with a control group of children. More than one-third of the injured children had been hospitalized (for periods ranging anywhere between 1 and 47 days). One year later, one injured child out of ten was still suffering from pain, and/or still being treated for injuries resulting from the accident. Many other factors were linked to the initial overall level of severity of the injuries, contrary to that of pain, such as the rate and duration of hospitalization, the duration of care provided, the number of medical consultations, and absenteeism from school. Children who had been injured in a road traffic accident were found to be more anxious and nervous, in general, as well as having a high prevalence of sleeping disorders in comparison to the children in the control group.

Fatal crashes involving young unlicensed drivers in the U.S

INTRODUCTION

Young unlicensed drivers' involvement in fatal crashes is a recurrent problem in the United States.

METHODS

This descriptive study extracted cross-sectional data on fatal crashes from the Fatality Analysis Reporting System from 1998 to 2002. Young unlicensed driver fatal crashes are examined by age, gender, and region.

RESULTS

There were 2,452 young unlicensed driver fatal crashes representing 10.8% of all young drivers' fatal crashes. By age, 72.5% are over 15 years, males are involved in 74.5%, and southern and western states have a higher percent of young unlicensed driver fatal crashes.

CONCLUSIONS

Subgroups of young people based on their age, gender, and region are over-represented in fatal crashes as unlicensed drivers. Further studies are needed to investigate the context and factors of young unlicensed drivers, essential to tailor interventions.

IMPACT ON INDUSTRY

Young unlicensed drivers circumvent the established licensing process and pose a serious threat to themselves and other road users.