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Multiple Risk Behavior and Injury
An International Analysis of Young People
William Pickett, PhD;
Holger Schmid, PhD;
William F. Boyce, PhD;
Kelly Simpson, BSc;
Peter C. Scheidt, MD, MPH;
Joanna Mazur, PhD;
Michal Molcho, MA;
Matthew A. King, BA;
Emmanuelle Godeau, MD;
Mary Overpeck, DrPH;
Anna Aszmann, MD;
Monika Szabo, MS;
Yossi Harel, PhD
Arch Pediatr Adolesc Med. 2002;156:786-793.
Background Multiple risk behavior plays an important role in the social etiology
of youth injury, yet the consistency of this observation has not been examined
multinationally.
Objective To examine reports from young people in 12 countries, by country, age
group, sex, and injury type, to quantify the strength and consistency of this
association.
Setting World Health Organization collaborative cross-national survey of health
behavior in school-aged children.
Participants A multinational representative sample of 49 461 students aged 11,
13, and 15 years.
Main Exposure Measures Additive score consisting of counts of self-reported health risk behaviors:
smoking, drinking, nonuse of seat belts, bullying, excess time with friends,
alienation at school and from parents, truancy, and an unusually poor diet.
Main Outcome Measure Self-report of a medically treated injury.
Results Strong gradients in risk for injury were observed according to the numbers
of risk behaviors reported. Overall, youth reporting the largest number ( 5
health risk behaviors) experienced injury rates that were 2.46 times higher
(95% confidence interval, 2.27-2.67) than those reporting no risk behaviors
(adjusted odds ratios for 0 to 5 reported behaviors: 1.00, 1.22, 1.48,
1.73, 1.98, and 2.46, respectively; P<.001 for
trend). Similar gradients in risk for injury were observed among youth in
all 12 countries and within all demographic subgroups. Risk gradients were
especially pronounced for nonsports, fighting-related, and severe injuries.
Conclusions Gradients in risk for youth injury increased in association with numbers
of risk behaviors reported in every country examined. This cross-cultural
finding indicates that the issue of multiple risk behavior, as assessed via
an additive score, merits attention as an etiological construct. This concept
may be useful in future injury control research and prevention efforts conducted
among populations of young people.
From the Department of Community Health and Epidemiology (Drs Pickett
and Boyce and Ms Simpson) and the Social Program Evaluation Group (Dr Boyce
and Mr King), Queen's University, and the Canadian Adolescents at Risk Research
Network (Drs Pickett and Boyce and Ms Simpson); Kingston, Ontario; the Swiss
Institute for the Prevention of Alcohol and Drug Problems, Lausanne, Switzerland
(Dr Schmid); the National Institute of Child Health and Human Development,
Bethesda, Md (Dr Scheidt); the National Research Institute of Mother and Child,
Warsaw, Poland (Dr Mazur); the Department of Sociology and Anthropology, Bar-Ilan
University, Ramat Gan, Israel (Ms Molcho and Dr Harel); the Service M dical
du Rectorat de Toulouse, Toulouse, France (Dr Godeau); the Maternal and Child
Health Bureau, Rockville, Md (Dr Overpeck); and the National Public Health
Centre, Budapest, Hungary (Dr Aszmann and Ms Szabo).
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