Project 1: High-Risk Behaviours
Common high-risk behaviours can have negative effects on young people’s overall development and well-being, and these behaviours can also be associated with injury occurrence. The Health Behaviour in School-Aged Children survey collects information on common risk behaviours including smoking status, binge drinking, drug use (including cannabis, prescription, and other illicit drug use), impaired driving, and engaging in physical fighting in Canada as well as 42 other countries or regions. We have explored these behaviours and their relationships to injury and these results have recently been published in the report entitled: Injury among young Canadians: A national study of contextual determinants.
Students who occasionally smoked cigarettes reported the highest proportion of any injury (57%) compared with nonsmokers (43%) and daily smokers (52%). The same pattern was observed among boys and girls. Similarly to any injuries, severe injuries were least common among non-smokers (22%). However, daily cigarette smokers reported the highest proportion of severe injuries.
Questions about the frequency of alcohol consumption in the last 12 months were asked of grades 9-10 students only. Binge drinking was defined as having five or more drinks during one occasion for boys, and four or more drinks during one occasion for girls. Students were categorized as binge drinking “often” if they reported this behaviour more than twice a month, and “sometimes” if they reported it once a month or less than once a month. Among boys and girls, the percentage of injured students increased as the frequency of binge drinking increased. A greater percentage of boys consistently reported being injured, regardless of injury severity or frequency of binge drinking. Overall, 54% of frequent binge drinkers reported an injury and 36% reported a severe injury. These findings were notably higher than students who reported never binge drinking.
Grades 9-10 students were asked about three types of drug use in the last 12 months: cannabis, prescription drugs (pain relievers, stimulants, and sedatives), and illicit drug use (cocaine, ecstasy, methamphetamine, etc.). Injuries were more common among students who indicated any kind of drug use compared with those who did not use drugs (Figure 3.9). The overall proportion of injuries was highest for misuse of prescription drugs (61%) and lowest for cannabis use (53%). The same pattern was observed for the different types of drugs and severe injuries.
Impaired driving or passenger of an impaired driver
Driving a motor vehicle while under the influence of alcohol or drugs is an obvious and serious cause of major injury in Canada. Therefore, it is disturbing that substantial proportions of boys and girls reported riding in a motor vehicle in the past 30 days that was driven by someone who had been using drugs or alcohol (ranging from 24%-33%) and 1-2% of these suffered a motor-vehicle related injury. More detailed descriptions of these patterns are provided in Pickett W, Davison C, Torunian M, McFaull S, Walsh P, Thompson W (2012) Drinking, Substance Use and the Operation of Motor Vehicles by Young Adolescents in Canada. PLoS ONE 7(8): e42807. doi:10.1371/journal.pone.0042807
Students were asked how many times they were in a physical fight during the past 12 months. Those who reported fighting on more than three occasions were considered to have engaged in this behaviour “often”. We found that the proportion of youth reporting being injured from any cause increased. Among students who physically fought, students in grade 9-10 report more injuries than grades 6-8 students. In total, 40% of grades 6-8 students and 47% of grades 9-10 students who often fought sustained a severe injury.
Project 2: Injury Among Young Canadians: A National Study of Contextual Determinants
Our nationally-focused research program has profiled the occurrence of adolescent injury and its potential determinants, studied inequalities in the occurrence of these injuries, and investigated high risk groups of adolescents. As of July 2013, this study has completed seven research projects as outlined below:
- Early clustering of high risk behaviours such as smoking, drinking, and early sex is associated with later occurrence of traumatic injury. This is a finding that crosses countries and cultures. Identification of high risk groups via this clustered risk-taking concept has the potential to be a point of intervention for major injury.
- Substantial portions of young Canadians report exposure to substances such as alcohol and drug use—either directly or as a passenger—through operators of on-road and off-road motor vehicles that they are riding on or in. These exposures are strongly related to the occurrence of transportation injuries. Such exposures are particularly high in rural and remote parts of Canada.
- Non-prescription substance abuse is an emerging trend among young people in Canada and early analyses suggests a strong correlation with the occurrence of injury. This finding is particularly evident in some geographic regions of Canada where the prevalence of use is higher.
- Strong inequities exist in bicycling injuries and helmet use between different groups of young people in Canada. Inequities can be defined according to social (e.g. economic) and demographic (e.g., age, gender, geography) factors. Such inequities point to the need for tailored interventions to meet the needs of at-risk groups.
- As with cycling injuries, similar inequities exist in the engagement of young people in the use of off-road vehicles and associated helmet use.
- Rural and remote student populations wait longer for paramedic services and have more limited access to these services for the treatment of major injury. This is documented nationally.
- In a national report funded jointly by the CIHR Team and the Public Health Agency of Canada, we documented strong gradients in risk for injury by social, economic and contextual factors, as well as by several established individual risk behaviours.
All of this information provides foundational knowledge for the development and targeting of focused interventions to prevent injury in high risk adolescent groups. This includes the content of programs aimed at different demographic groups (e.g., gender and age group), geographical groups (e.g., rural and remote areas of Canada), and by socio-economic status (SES) groups (e.g., low SES groups for some types of injury, as well as high economic groups for sports-related injury).