The epidemiology of non-fatal injuries among 11, 13, and 15 year old youth in 11 countries: findings from the 1998 WHO-HBSC study

1
The epidemiology of non-fatal injuries among 11,
13, and 15 year old youth in 11 countries
findings from the 1998 WHO-HBSC study

• Presenting author
• Michal Molcho

Reference Molcho M., Harel Y., Pickett W.
Schiedt P.C., Mazur J. Overpeck M.D. (2006). The
epidemiology of non fatal injuries among 11, 13
and 15 year old youth in 11 Countries Findings
from the 1998 WHO-HBSC cross national survey.
Injury Control and Safety Promotion (In press).
2
HBSC - background

• A cross-national research study conducted in
  collaboration with the WHO Regional Office for
  Europe
• HBSC was initiated in 1982 and is conducted every
  4 years
• HBSC 1998 involved more than 125,000 children
  from 29 countries
• HBSC 2006 is expected to involve more than
  180,000 children from 41 countries

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HBSC 2006 41 regions
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HBSC some more background

• The study aims to gain new insight into, and
  increase our understanding of young people's
  health and well-being, health behaviours and
  their social context

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HBSC topics covered

• Demographics
• General health and well-being
• Family and peer relationships
• School environment
• Exercise and leisure time activities
• Substance use
• Violence and injuries
• Etc.

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HBSC some more background

• The findings are used to inform and influence
  childrens policy and practice at national and
  international levels
• The target age-groups are 11, 13 and 15 year olds
  attending school (n4,500)
• Sample sizes assured a 95 confidence interval of
  /- 3 for prevalence estimates

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Methodology - Data

• 1998 HBSC data from 11 countries Belgium
  (Flemish sample), Canada, England, Hungary,
  Israel, Lithuania, Poland, Republic of Ireland,
  Sweden, Switzerland, and the USA
• Sample of 52,955 schoolchildren

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Methodology Measures

• Self reported medically attended injuries P12M
• During the past 12 months, how many times were
  you injured, and had to be treated by a doctor or
  a nurse?

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Methodology Measures

• Measures of severity
• Injury that resulted with one or more days missed
  from school or usual activities
• Injury that resulted in two or more of the
  following treatments placement of a cast,
  stitches, use of crutches and surgery or injury
  that resulted with overnight hospitalization
• Measures of severity were collected in 8 of the
  11 countries

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Methodology Measures

• Setting in which the injury occurred
• Where were you when this one most serious injury
  happened?
• Activity during which the injury occurred
• What were you doing when this one most serious
  injury happened?

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Findings

• International comparison of injuries

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Annual rates of medically attended injury and
measures of severity per 100 by country
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Medically attended injury Cross-tabulation of
injuries, by setting and activity context for all
11 countries combined
Home (or yard) School Sport Facility/Field Street Other Total
Biking 27.6 8.2 7.7 46.7 9.7 100.0
14.0 5.0 4.4 39.3 10.2 13.3
Sport Activity 12.9 31.2 47.9 2.6 5.3 100.0
16.5 47.9 68.5 5.5 14.1 33.5
Walking/Running 34.2 26.1 7.3 20.2 12.2 100.0
17.1 15.7 4.1 16.7 12.6 13.1
Other 41.6 18.3 7.0 7.2 25.9 100.0
39.8 21.0 7.5 11.4 51.3 25.1
Total 3,866 3,212 3,450 2,330 1,869 14,727
26.3 21.8 23.4 15.8 12.7 100.0
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Country specific medically attended annual injury
estimates by setting per 100 injured persons
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Main findings - prevalence

• Country variation in medically attended injury
  percentage from about 24 in Poland to about 50
  in Israel
• Striking consistency with respect to the
  locations and mechanisms
• In all 11 countries boys experienced more
  injuries than girls
• No clear age trend was found internationally

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Country specific medically attended annual injury
estimates by activity per 100 injured persons
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Main findings bicycle injuries

• High rates of bicycle relates injuries in Hungary
  (21.6) and lower rates in Sweden, Canada and the
  US (11.8, 8.0 and 8.0 respectively).
• Klein et al.(2005) reported the relative lack of
  programs on bicycle safety for Hungary and more
  programs for Sweden, Canada and the US that
  corresponded with the percentages of school
  children using bicycle helmets in these countries
  
• This may suggest that informed legislation and
  other injury prevention programs can play an
  important role in decreasing injury rates at the
  national level

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Cross-tabulation of severe injury rates by
activity and type of severity measure for all
countries combined
Type of activity Activity loss Activity loss Consequences Consequences
N N
Biking 1,913 13.0 1,947 14.8
Skating 1,131 7.5 1,157 9.1
Sport Activity 4,691 31.6 4,798 27.5
Riding in a Car 423 2.8 428 4.6
Walking/Running 1,771 11.7 1,835 12.7
Fighting 548 3.8 109 3.8
Other 3,462 29.7 3,513 27.6
Total 13,904 100.0 14,234 100.0
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Main findings fighting

• Overall, about 4 of all reported injuries were
  caused by fighting and this figure was consistent
  across the 11 countries
• injuries due to fighting were responsible for
  only about 4 of all severe injuries, based upon
  both measures of severity used

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Conclusions

• So what have we learned?

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Conclusions

• The high rates of injury among youth, in all 11
  countries that collected these data in the WHO
  HBSC study indicate the universality of this
  problem
• The cross-national similarities in locations are
  compelling
• The three leading locations home, school and
  sport facilities should be targeted as a high
  priority worldwide

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Limitations

• The HBSC study does not provide in-depth
  information on injuries
• data were collected during school class period.
  Thus, youth who were not in attendance at school
  were not represented
• The study also relies upon self-reports and this
  involves use of individual students perceptions

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More injury papers from the HBSC

• Mazur J., Scheidt P.C., Overpeck M.D., Harel Y.,
  Molcho M. (2001). "Adolescents injuries in
  relation to economic status An International
  perspective". Journal of Injury Control and
  Safety Promotion, 8(3) 179-182.
• Pickett W., Garner M.J., Boyce W.F. and King
  M.A.(2002) Gradients in risk for youth injury
  associated with multiple-risk behaviours a study
  of 11,329 Canadian adolescents. Social Science
  and Medicine, 55(6)1055-68.
• Pickett W. Schmid H. Boyce W.F. Simpson K.
  Scheidt P.C. Mazur J. Molcho M. King M.A..
  Godeau E. Overpeck M. Aszmann A. Szabo M.
  Harel Y. (2002). "Multiple risk behavior and
  injury an international analysis of young
  people". Archives of Pediatrics and Adolescent
  Medicine, 156786-793

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More injury papers from the HBSC

• Pickett W, Molcho M, Simpson K, Janssen I,
  Kuntsche E, Mazur L, Harel Y, and Boyce WF
  (2005). Cross-national study of injury and
  social determinants in adolescents. Injury
  Prevention, 11213-218.
• Klein, K.S. Thompson, D. Scheidt P.C.
  Overpeck, M.D. Gross, L.A. (2005). Factors
  associated with bicycle helmet use among young
  adolescents in a multinational sample. Injury
  Prevention, 0001-7.
• Pickett W., Craig W., Harel Y., Cunningham J.,
  Simpson K., Molcho M., Mazur J., Dostaler S. and
  Currie C.E. (2005). Cross-national study of
  fighting and weapon carrying as determinants of
  adolescent injury. Pediatrics 116(6)855-863.