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 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. Vienna: 26 June, 2006Dr Michal Molcho, NUI Galway 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

3. Vienna: 26 June, 2006Dr Michal Molcho, NUI Galway HBSC 2006 – 41 regions

4. Vienna: 26 June, 2006Dr Michal Molcho, NUI Galway 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

5. Vienna: 26 June, 2006Dr Michal Molcho, NUI Galway 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.

6. Vienna: 26 June, 2006Dr Michal Molcho, NUI Galway HBSC – some more background The findings are used to inform and influence children’s policy and practice at national and international levels The target age-groups are 11, 13 and 15 year olds attending school (n=4,500) Sample sizes assured a 95% confidence interval of +/- 3% for prevalence estimates

7. Vienna: 26 June, 2006Dr Michal Molcho, NUI Galway 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

8. Vienna: 26 June, 2006Dr Michal Molcho, NUI Galway 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?

9. Vienna: 26 June, 2006Dr Michal Molcho, NUI Galway 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

10. Vienna: 26 June, 2006Dr Michal Molcho, NUI Galway 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?

11. Findings International comparison of injuries

12. Vienna: 26 June, 2006Dr Michal Molcho, NUI Galway Annual rates of medically attended injury and measures of severity per 100 by country

13. Vienna: 26 June, 2006Dr Michal Molcho, NUI Galway Medically attended injury: Cross-tabulation of injuries, by setting and activity context for all 11 countries combined Home (or yard) SchoolSport Facility/Field StreetOtherTotal Biking27.68.27.746.79.7100.0 14.05.04.439.310.213.3 Sport Activity12.931.247.92.65.3100.0 16.547.968.55.514.133.5 Walking/Running34.226.17.320.212.2100.0 17.115.74.116.712.613.1 Other41.618.37.07.225.9100.0 39.821.07.511.451.325.1 Total3,8663,2123,4502,3301,86914,727 26.321.823.415.812.7100.0

14. Vienna: 26 June, 2006Dr Michal Molcho, NUI Galway Country specific medically attended annual injury estimates by setting per 100 injured persons

15. Vienna: 26 June, 2006Dr Michal Molcho, NUI Galway 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 Main findings - prevalence

16. Vienna: 26 June, 2006Dr Michal Molcho, NUI Galway Country specific medically attended annual injury estimates by activity per 100 injured persons

17. Vienna: 26 June, 2006Dr Michal Molcho, NUI Galway 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 Main findings – bicycle injuries

18. Vienna: 26 June, 2006Dr Michal Molcho, NUI Galway Cross-tabulation of severe injury rates by activity and type of severity measure for all countries combined Type of activityActivity lossConsequences N%N% Biking1,91313.01,94714.8 Skating1,1317.51,1579.1 Sport Activity4,69131.64,79827.5 Riding in a Car4232.84284.6 Walking/Running1,77111.71,83512.7 Fighting5483.81093.8 Other3,46229.73,51327.6 Total13,904100.014,234100.0

19. Vienna: 26 June, 2006Dr Michal Molcho, NUI Galway 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 Main findings – fighting

20. Conclusions So what have we learned?

21. Vienna: 26 June, 2006Dr Michal Molcho, NUI Galway 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 Conclusions

22. Vienna: 26 June, 2006Dr Michal Molcho, NUI Galway 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 Limitations

23. Vienna: 26 June, 2006Dr Michal Molcho, NUI Galway 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, 156:786-793 More “injury” papers from the HBSC

24. Vienna: 26 June, 2006Dr Michal Molcho, NUI Galway 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, 11:213-218. 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, 000:1-7. 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. More “injury” papers from the HBSC