OBJECTIVES. National data are not routinely available regarding the incidence of and associated risk factors for nonfatal injuries in children and youth. The Child Health Supplement to the 1988 National Health Interview Survey provided an opportunity to determine accurate national estimates of childhood injury morbidity by demographic factors, location, external cause, nature of injury, and other factors. METHODS. The closest adult for 17,110 sampled children was asked whether the child had had an injury, accident, or poisoning during the preceding 12 months and about the cause, location, and consequences of the event. An analysis for potential underreporting from 12 months of recall provided adjustments of annual rates to those for a 1-month recall period. RESULTS. On the basis of 2772 reported injuries, the national estimated annual rate for children 0 to 17 years of age was 27 per 100 children after adjustment to 1-month recall. Boys experienced significantly higher rates than girls (risk ratio [RR] = 1.52, 95% confidence interval [CI] = 1.37, 1.68), and adolescents experienced the highest overall rate (38 per 100 children) and proportion of serious injuries. CONCLUSIONS. Approximately one fourth of US children experience a medically attended injury each year, but the risks vary considerably depending on the characteristics of subgroups and the injury cause.

OBJECTIVES. This study used a recent national population survey on childhood and adolescent non-fatal injuries to investigate the effects of recall bias on estimating annual injury rates. Strategies to adjust for recall bias are recommended. METHODS. The 1988 Child Health Supplement to the National Health Interview Survey collected 12-month recall information on injuries that occurred to a national sample of 17,110 children aged 0 through 17 years. Using information on timing of interviews and reported injuries, estimated annual injury rates were calculated for 12 accumulative recall periods (from 1 to 12 months). RESULTS. The data show significantly declining rates, from 24.4 per 100 for a 1-month recall period to 14.7 per 100 for a 12-month recall period. The largest declines were found for the 0- through 4-year-old age group and for minor injuries. Rates of injuries that caused a school loss day, a bed day, surgery, or hospitalization showed higher stability throughout recall periods. CONCLUSIONS. Varying recall periods have profound effects on the patterns of childhood injury epidemiology that emerge from the data. Recall periods of between 1 and 3 months are recommended for use in similar survey settings.

ABSTRACT. Objectives. We sought to (1) compare estimates of the prevalence of fighting and weapon carrying among adolescent boys and girls in North American and European countries and (2) assess in adolescents from a subgroup of these countries comparative rates of weapon carrying and characteristics of fighting and injury outcomes, with a determination of the association between these indicators of violence and the occurrence of medically treated injury.Design and Setting. Cross-sectional self-report surveys using 120 questions were obtained from nationally representative samples of 161 082 students in 35 countries. In addition, optional factors were assessed within individual countries: characteristics of fighting (9 countries); characteristics of weapon carrying (7 countries); and medically treated injury (8 countries).Participants. Participants included all consenting students in sampled classrooms (average age: 11-15 years).Measures. The primary measures assessed included involvement in physical fights and the types of people involved; frequency and types of weapon carrying; and frequency and types of medically treated injury.Results. Involvement in fighting varied across countries, ranging from 37% to 69% of the boys and 13% to 32% of the girls. Adolescents most often reported fighting with friends or relatives. Among adolescents reporting fights, fighting with total strangers varied from 16% to 53% of the boys and 5% to 16% of the girls. Involvement in weapon carrying ranged from 10% to 21% of the boys and 2% to 5% of the girls. Among youth reporting weapon carrying, those carrying handguns or other firearms ranged from 7% to 22% of the boys and 3% to 11% of the girls. In nearly all reporting countries, both physical fighting and weapon carrying were significantly associated with elevated risks for medically treated, multiple, and hospitalized injury events. 11 Results from these studies have broadened our knowledge of the global impact that adolescent violence has on public health. Existing international comparisons of youth violence have focused on the frequency of adolescent violence-related behaviors in a small number of countries, 12 comparisons of episodes of school violence and its determinants in Israeli and Arabic student populations, 13 studies of "child soldiers" in countries engaged in civil and international warfare, 14,15 international comparisons of firearmrelated mortality, 3 and, as part of more general international comparisons, examinations of firearm regulations and rates of homicide, 3,16,17 robberies and sexual assaults, 17,18 and suicide. 16 Beyond studies of firearms, international comparisons of rates of youth violence are still lacking, and the magnitude and nature of the adolescent violence problem remains unknown for many countries. Cross-national comparisons of violent behaviors in youth have been problematic, because of the use of nonrepresentative samples in many countries and a lack of uniformity in study designs. ConclusionsPhysical fighting and engagement in weapon carry...

Objectives: To compare estimates of the prevalence of injury among adolescents in 35 countries, and to examine the consistency of associations cross nationally between socioeconomic status then drunkenness and the occurrence of adolescent injury. Design: Cross sectional surveys were obtained from national samples of students in 35 countries. Eight countries asked supplemental questions about injury. Setting: Surveys administered in classrooms. Subjects: Consenting students (n = 146 440; average ages 11-15 years) in sampled classrooms. 37 878 students (eight countries) provided supplemental injury data. Exposure measures: Socioeconomic status (material wealth, poverty) and social risk taking (drunkenness). Outcome measures: Specific types and locations of medically treated injury. Results: By country, reports of medically treated injuries ranged from 33% (1060/3173) to 64% (1811/ 2833) of boys and 23% (740/3172) to 51% (1485/2929) of girls, annually. Sports and recreation were the most common activities associated with injury. High material wealth was positively (OR.1.0; p,0.05) and consistently (6/8 countries) associated with medically treated and sports related injuries. Poverty was positively associated with fighting injuries (6/8 countries). Drunkenness (social risk taking) was positively (p,0.01) and consistently (8/8 countries) associated with medically treated, street, and fighting injuries, but not school and sports related injuries. Conclusion: The high prevalence of adolescent injury confirms its importance as a health problem. Social gradients in risk for adolescent injury were illustrated cross nationally for some but not all types of adolescent injury. These gradients were most evident when the etiologies of specific types of adolescent injury were examined. Prevention initiatives should focus upon the etiologies of specific injury types, as well as risk oriented social contexts.

Adolescents in 5 countries behaved similarly in their expression of violence-related behaviors. Occasional fighting and bullying were common, whereas frequent fighting, frequent bullying, any weapon carrying, or any fighting injury were infrequent behaviors. These findings were consistent across countries, with little cross-national variation except for bullying rates. Traditional risk-taking behaviors (smoking and drinking) and being bullied were highly associated with the expression of violence-related behavior.