Pickett William, Garner Michael J, Boyce William F, King Matthew A
Department of Emergency Medicine, Queen's University, Kingston General Hospital, ON, Canada.
Soc Sci Med. 2002 Sep;55(6):1055-68. doi: 10.1016/s0277-9536(01)00224-6.
This study used the Canadian version of the World Health Organization-Health Behaviour in School-Aged Children (WHO-HBSC) Survey to examine the role of multiple risk behaviours and other social factors in the etiology of medically attended youth injury. 11,329 Canadians aged 11-15 years completed the 1997-1998 WHO-HBSC, of which 4152 (36.7%) reported at least one medically attended injury. Multiple logistic regression analyses failed to identify an expected association between lower socio-economic status and risk for injury. Strong gradients in risk for injury were observed according to the numbers of multiple risk behaviours reported. Youth reporting the largest number (7) of risk behaviours experienced injury rates that were 4.11 times (95% CI: 3.04-5.55) higher than those reporting no high risk behaviours (adjusted odds ratios for 0-7 reported behaviours: 1.00, 1.13, 1.49, 1.79, 2.28, 2.54, 2.62, 4.11; p(trend) < 0.001). Similar gradients in risk were observed within subgroups of young people defined by grade, sex, and socio-economic level, and within restricted analyses of various injury types (recreational, sports, home, school injuries). The gradients were especially pronounced for severe injury types and among those reporting multiple injuries. The analyses suggest that multiple risk behaviours may play an important role in the social etiology of youth injury, but these same analyses provide little evidence for a socio-economic risk gradient. The findings in turn have implications for preventive interventions.
本研究采用世界卫生组织学龄儿童健康行为（WHO-HBSC）调查的加拿大版本，以检验多种风险行为和其他社会因素在就医青少年伤害病因学中的作用。11329名11至15岁的加拿大人完成了1997 - 1998年的WHO-HBSC调查，其中4152人（36.7%）报告至少有一次就医伤害。多项逻辑回归分析未能确定社会经济地位较低与伤害风险之间的预期关联。根据报告的多种风险行为数量，观察到伤害风险存在明显梯度。报告风险行为数量最多（7种）的青少年的伤害发生率比未报告高风险行为的青少年高4.11倍（95%可信区间：3.04 - 5.55）（报告0 - 7种行为的调整比值比：1.00、1.13、1.49、1.79、2.28、2.54、2.62、4.11；p趋势<0.001）。在按年级、性别和社会经济水平定义的青少年亚组中，以及在对各种伤害类型（娱乐、体育、家庭、学校伤害）的受限分析中，也观察到了类似的风险梯度。这些梯度在严重伤害类型和报告多处伤害的人群中尤为明显。分析表明，多种风险行为可能在青少年伤害的社会病因学中起重要作用，但同样的分析几乎没有为社会经济风险梯度提供证据。这些发现进而对预防干预措施具有启示意义。
