Characteristics and related factors of nonfatal injuries among adolescents and college students in Shenzhen city of China

BMC Public Health Characteristics and related factors of nonfatal injuries among adolescents and college students in Shenzhen city of China Li Zhou 0 Dingyan Chen 0 Guoying Dong 0 0 Shenzhen Center for Disease Control and Prevention , No. 8 Longyuan Road, Nanshan District, Shenzhen, Guangdong Province 518055 , China Background: Injuries impact adolescents and young adults in unique ways. The purpose of this study was to determine the incidence rate of nonfatal injuries, and identify characteristics and risk factors for the injuries among adolescents and college students in Shenzhen, China. Methods: A total of 4,138 students from 79 classes were selected using a purposive sampling method in 2010. The questionnaire included personal demographics, behavioral factors, and self-perceived agrypnia. Stepwise multivariate logistic regression models were used to explore the risk factors of injury. Results: The annual incidence rate of nonfatal injuries was 13.5%. Injuries were significantly correlated with gender (boys vs. girls, adjusted odds ratio [OR], 1.58, 95% confidence interval [CI], 1.30-1.93) and self-perceived agrypnia (sometimes vs. no, adjusted OR, 1.64, 95% CI, 1.31-2.05; often vs. no, adjusted OR, 2.34, 95% CI, 1.74-3.14), attending PE class ( >2 classes/week vs. 2 classes/week, adjusted OR, 1.25, 95% CI, 1.04-1.51), sexual behaviors (yes vs. no, adjusted OR, 1.46, 95% CI, 1.03-2.07), physical fighting (yes vs. no, adjusted OR, 1.84, 95% CI, 1.49-2.28), alcohol consumption (yes vs. no, adjusted OR, 1.29, 95% CI, 1.06-1.59), unsafe cycling (yes vs. no, adjusted OR, 1.47, 95% CI, 1.20-1.80) and skating in unsafe places (yes vs. no, adjusted OR, 1.57, 95% CI, 1.10-2.24). Additionally, falls were the leading cause of injuries, and gymnasiums of schools were the most-reported places where injuries occurred. Conclusions: Nonfatal injuries have turned into a pressing public health problem among adolescents and college students in Shenzhen, China. Strategies targeting the risk factors may be effective for the prevention of injuries. Injury risk; Injury rate; Adolescent; Students - Background Injuries are an emerging public health problem around the world that affect all age population, especially adolescents and young adults. It is reported that globally an estimated 5.8 million people die from injuries each year [1]. For people aged 5 to 29 years old, injuries are the leading cause of death [1]. In particular, injuries and injury-related deaths have an inestimable impact on the families and communities affected, whose lives are often irrevocably altered by the tragedies. In China, more than 10% of all deaths result from injuries and premature mortality, accounting for more than 30% of all potentially productive years of life lost [2]. The Ministry of Health of China reported that the annual incidence of injuries for all-age population was between 16.1% and 21.9%, and 700750,000 people die as a result of injuries each year in China [3,4]. Additionally, injuries incidence among youths was reported to be about 50% [5]. As a result, it is desirable to conduct prevention research to protect young people against injuries. A precondition for developing effective prevention strategies to cope with the rapid growth of injuries is a sufficient understanding of the incidence and risk factors of injuries. In the past several decades, many studies have been conducted on injuries among the young population [6-11]. However, most published studies that identified various sociodemographic and behavioral factors related to injuries have focused on the populations in developed countries, and the information in developing countries remains unclear. Shenzhen, located in the southern tip of China and neighboring Hong Kong, was the first Special Economic Zone established in China in the 1980s. The educational system in Shenzhen has developed rapidly as a consequence of rapid economic development, resulting in large numbers of students and schools spread throughout the city. Since injury is particularly likely to affect students, in this study we aimed to find out (1) What was the incidence rate of nonfatal injuries among adolescents and college students in Shenzhen? (2) What were the characteristics of these injuries? (3) What were the major risk factors among adolescents and the college students? The goal was to develop suggestions for more effective measures in injuries prevention in the future. Methods Study area, subjects and sampling method Data for this study were collected using a cross-sectional survey design. The sample pool included all the districts in Shenzhen City. According to the Shenzhen Municipal Bureau of Statistics, there were 10.35 million permanent residents living in the city in 2010 [12], making Shenzhen one of the largest cities in China. Additionally, the educational system has also developed rapidly. By the end of 2009, there were 1,636 schools and around 1.27 million students in Shenzhen [13]. We utilized a purposive sampling method to select 16 schools (7 junior high schools, 7 senior high schools and 2 colleges) from 6 districts of Shenzhen. We used grade as stratum, selecting classes by cluster sampling in each stratum. All the students in the selected classes agreeing to participate in the survey were recruited. In total, 4,209 students in 79 selected classes were surveyed and 4,138 of them completed the survey correctly, yielding a response rate of 97.3%. Data collection procedure The data were collected between October 2010 and December 2010 in Shenzhen using the questionnaire of the Guangdong Provincial Childrens Health Behavior Survey (GPCHBS), which was designed by the Children and Adolescents/School Health Center of the Chinese Center for Disease Control and Prevention. The GPCHBS is cross-sectionally administered in 21 areas (8 urban and 13 rural areas) in Guangdong province every three years. Shenzhen is one of the selected areas. The questionnaire was administered voluntarily and anonymity was assured to protect the respondents privacy. All investigators were trained before the survey. The dependent variable was measured by the response to a question: During the past 12 months, how many times were you seriously injured? A serious injury was defined as an injury that required treatment by a doctor or nurse or resulted in missing at least one full day of usual activities (such as going to school or taking part in sports). The variable was dichotomized into No vs. Yes for all the analyses. Two follow-up questions were asked about symptoms of the injuries and places where injuries occurred, respectively. Independent variables consisted of demographic characteristics (including gender, age, height, weight, grade, registered permanent residence), behavioral factors (trying smoking, alcohol consumption, unsafe cycling, not walking on zebra crossing lines or pedestrian overpass or underpass, swimming in unsafe places, skating in unsafe places, physica (...truncated)