Department of Epidemiology and Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Information, Monitoring and Evaluation Department, Ghana Health Service, Ho Polyclinic, Ho, Ghana.
Front Public Health. 2023 Jul 20;11:1193711. doi: 10.3389/fpubh.2023.1193711. eCollection 2023.
Adolescent use of substances and injury experiences such as head injury have become increasingly prevalent. However, information regarding their association and the potential pathways linking them remains limited. This study examined the association between substance use and injuries, emphasizing the mediating role of interpersonal violence among adolescents.
We employed a multi-country analysis of Global School-based Health Surveys of 122,945 in-school adolescents aged 11-18 from 29 countries. This study was a cross-sectional school-based, nationally representative study developed by the World Health Organization and the United States Centers for Disease Control and Prevention, other United Nations allies, and country-specific institutions. Random-effects meta-analysis was performed to estimate the overall prevalence of injury and substance use and the I-square ( statistic was used to investigate the between-country heterogeneity. Logistic regression models were fitted to examine the association between substance use and injuries. A path analysis was used to examine the potential mediation effect of interpersonal violence and employed decomposition of effects into total, direct, and indirect.
Prevalence of substance use and injuries were 33.6% (95%CI = 28.5, 38.6%) and 41.7% (95%CI = 37.3, 46.1%), respectively. Substance use (37.8% vs. 29.4%, = 0.001) and injuries (47.3% vs. 36.4%, = 0.001) were significantly higher among male adolescents than females, respectively. After adjustment, substance users had 40% higher odds of injuries. The path analysis showed a mediation effect of perpetration of and victimization by interpersonal violence on the association of substance use with injuries, with total positive effects of perpetration [ 0.18; 95%CI = 0.16, 0.19; = 0.001] and victimization on injuries [ 0.22; 95%CI = 0.21, 0.24; = 0.001]. In a further subgroup analysis, tobacco users were 3.98 times more likely to sustain a gunshot wound whiles marijuana users had 2.81 times higher odds of sustaining gunshot wounds. Cigarette smokers had 45% lower odds of sustaining cut/stab wounds. Alcohol users were 53% more likely to sustain concussion/head injury and two and half times more likely to sustain gunshot wound.
A significant association exists between substance use and severe injuries among adolescents, mediated by interpersonal violence exposure. Our findings may have utility in informing substance use and interpersonal violence control policies and interventions to address adolescent injuries.
青少年物质使用和头部受伤等伤害经历变得越来越普遍。然而，关于它们之间的关联以及潜在联系的信息仍然有限。本研究考察了物质使用与伤害之间的关联，强调了青少年中人际暴力的中介作用。
我们利用了来自 29 个国家的 122945 名 11-18 岁在校青少年的全球学校健康调查的多国分析。这项研究是一项由世界卫生组织和美国疾病控制与预防中心、其他联合国盟友以及国家特定机构制定的全国代表性的基于学校的横断面研究。采用随机效应荟萃分析估计损伤和物质使用的总体流行率，采用 I 平方（ 统计量来研究国家间的异质性。采用逻辑回归模型来检验物质使用与损伤之间的关联。采用路径分析检验人际暴力的潜在中介效应，并对总效应、直接效应和间接效应进行效应分解。
物质使用和损伤的发生率分别为 33.6%（95%CI=28.5,38.6%）和 41.7%（95%CI=37.3,46.1%）。与女性相比，男性青少年的物质使用（37.8%比 29.4%， = 0.001）和损伤（47.3%比 36.4%， = 0.001）发生率显著更高。调整后，物质使用者受伤的可能性高出 40%。路径分析显示，人际暴力的实施和受害对物质使用与损伤之间的关联存在中介作用，人际暴力的实施具有正向总效应[0.18；95%CI=0.16,0.19； = 0.001]和受害的正向总效应[0.22；95%CI=0.21,0.24； = 0.001]。在进一步的亚组分析中，吸烟草的人发生枪伤的可能性高出 2.81 倍，而吸食大麻的人发生枪伤的可能性高出 3.98 倍。吸烟者发生切割/刺伤的可能性降低 45%。饮酒者发生脑震荡/头部受伤的可能性增加 53%，发生枪伤的可能性增加 2.5 倍。
物质使用与青少年严重损伤之间存在显著关联，人际暴力的暴露起中介作用。我们的研究结果可能有助于为青少年损伤提供物质使用和人际暴力控制政策和干预措施的信息。
