Global Unintentional Injury among Children and Adolescents
JORDAN AMATUEGWU
PSYC-6778-4/PUBH-6115-4
Social, Behavioral, and Cultural Factors in Public Health
Definition of Population, Incidence, Prevalence and Significance
Injuries, both intentional and unintentional, are the leading cause of death and disability for people younger than 20 years of age and account for billions of deaths globally. This paper will focus on the issues surrounding the unintentional injuries among children and adolescents.
The rate of injury among children and adolescents poses a health care burden to every country. Most of these injuries result from motor vehicle collisions, drowning, poisoning, falls or burns, assault, and self-inflicted violence (WHO, 2010). According to Mello (2007), the health care burden caused by unintentional injuries among children and adolescents results in years of lost productivity, which varies from country to country.
Approximately 47% of unintentional injuries are recorded among children and adolescents globally (WHO, 2010). The two leading causes of unintentional injuries among these populations are known to be motor vehicle accidents (39%) and drowning (14%). Also, as mentioned above, children and adolescents are vulnerable to unintentional injuries, and the causes of death or mortality from unintentional injuries differ among these two populations. For example, younger children are more prone to poisoning, drowning, burns, and mistreatment, while road traffic and sports injuries tend to affect older children and adolescents. Similarly, Mello (2007) mentioned how alcohol use contributes to motor traffic accidents as a common cause of unintentional injury among adolescents. The World Health Organization published statistics showing that the rate of unintentional injuries per 100,000 children varies based on income level per country. Low-income countries (LIC) have higher rates of unintentional injury when compared to high-income countries (HIC). For example, low-income countries including Africa, parts of the Americas, Southeast Asia, parts of Europe, parts of the Eastern Mediterranean and parts of the Western Pacific had unintentional injury rates of 53.1%, 21.8%, 49.0%, 25.4%, 45.7%, and 33.8% respectively. By comparison, high-income countries of the Americas, Europe, Eastern Mediterranean and West Pacific had rates that were significantly lower at 14.4%, 7.9%, 41.6%, and 7.8% respectively (WHO,20008).
There is published data describing how deaths due to unintentional injuries are only a portion of those who have been victimized (Mello, 2007; Ham, 2007; Sethi, Glen, & Farchi, 2009). These studies described how outpatient visits, hospitals and emergency rooms are flooded with persons who are victims of unintentional injuries. For example, in South Korea, the utilization of emergency rooms for unintentional injuries was about 289.2 per 100,000 (Ham, 2007). Similarly, in Europe, there are approximately three million hospital admissions and 37 million emergency room visits due to unintentional injuries in the age group of 0 to 14 years (Sethi, Glen, & Farchi, 2009). In the United States, an estimated eight million emergency department visits were for treatment of alcohol-related injuries (Mello, 2007).
The occurrence of unintentional injuries as other causes of death and mortality are not random events that happen because of fate, they occur following identifiable risk factor patterns. The burden upon healthcare caused by unintentional injuries in these populations – among both children and adolescents – warrant attention from the government, public officials, policy makers, stakeholders, and others, to identify the related risk factors leading to unintentional injuries among children and adolescents (Sethi, Galan, & Farchi, 2009). Such identification will also encourage the development of evidence-based interventions that would reduce unintentional injuries among these groups.
Behavior Dimensions
The relationships between unintentional injuries among children and adolescents have been well documented (Schintzer & Ewigman, 2008). Differences in socioeconomic status and the closeness of relationship among relationship of household members have been documented to contribute to the high rate of unintentional injuries observed in these populations. According to Schintzer and Ewigman (2008), unemployed, low socioeconomic status, and male gender were established risk factors for unintentional injuries. Persons living in foster homes or residing in the homes of families unrelated to them were six times more likely to die from neglect, malnutrition, and mistreatment related to unintentional injuries (Schintzer & Ewigman, 2008). In addition, in the United States alone, 42.2% of deaths have been reported as result of mistreatment unintentional injuries (Schintzer & Ewigman, 2008). At the same time, alcohol and male gender were major contributing factors associated with unintentional injuries among adolescents (Mello, 2007). Inequalities between socioeconomic groups in terms of the rate of unintentional injury have been established. According to the World Health Organization (WHO) and related studies, unintentional injuries are the leading cause of death and mortality in low-income and middle-income countries, and those who are chronically poor are more prone to experience injuries. Furthermore, in low-income families there often is a lack of supervision; moreover, parents may not be able to afford safety equipment such as smoke alarms and safety helmets. These persons are also more likely to be living in over-crowded homes with unprotected windows, outdated cribs, and stairs without hand rails, and in cramped living conditions that might be exposed to open cooking fires (WHO, 2008). On the contrary, unintentional injuries in high-income countries are mostly due to the behavior of the “manufactures, engineers, and business leaders” in charge of products that lead to unintentional injuries among children and adolescents. As Gielen and Girasek (2008) mentioned, the many causes of unintentional injuries in high-income countries such as the United States “are the outcome of interactions between humans and products” (p.210). This implies that high-income countries are more advanced in the use of motor vehicles, toys, swimming pools, toys, food, medication, cleaning products, ladders, and others, and the use of these products increases the risk of unintentional injuries encountered among children and adolescents in these populations. For example, placing a child in the front seat without buckling their seat belt is a primary cause of unintentional injuries and death in children and adolescents in United States (Schnitzer & Ewigman, 2008).
Psychosocial dimensions
Although there is established data about the behaviors that lead to unintentional injuries among children and adolescents, there has not been enough documentation regarding people’s perceptions of injury risk (Dal Santo, Goodman, Glick, & Jackson, 2010). Persons who live in stressed, less-educated families can be perceived as aggressive and difficult to supervise and, thus, suffer higher rate of injuries (Dal Santo, Goodman, Glick, & Jackson, 2010; Valle, Gosney, & Sinclair, 2008). In addition, children require supervision as they explore their surroundings and need assistance in making the right decisions when interacting with their environment. Dal Santo, Goodman, Glick and Jackson (2010) described how parent supervision affected childhood injury risk: an increased supervision resulted in lower injuries, and reduced supervision resulted in higher risk of injury. However, in adolescents, although injury supervision plays a role; their primary issue is a “difficulty in trying to negotiate how to deal with complex emotions and relationships” (Valle, Gosney, & Sinclair, 2008, p. 721). The authors explained that in a review of 77 cases of adolescent deaths, 20.8% deaths were directly related to alcohol and drug-related misuse and 53.2% died of unintentional injuries and poisoning. Again, research has shown that adolescents at risk of unintentional injuries are those who live in poverty, have low family income, and are the victims of abuse or violence (Valle, Gosney, & Sinclair, 2008). The adolescent years are known to be a time of experimentation with sexual identity and drugs, with an emphasis on self-esteem, and self-awareness, which are heightened by the media and other social factors (Valle, Gosney, & Sinclair, 2008). The authors noted that unintentional injuries resulting from sexual experimentation, such as autoerotic asphyxiation and prostitution, as well as sexual abuse, alcohol and substance abuse, are common.
Environmental Dimensions:
The relationship between the environment and unintentional injury has been well documented (WHO, 2008; Morrongiello, Klemencic, & Corbett, 2008; Hyder, Sugerman, Puvanachandra, El-Sayed, Isaza, Rahaman, & Peden, 2008). The role the environment has in unintentional injuries varies globally, depending on whether the victims are in high-income countries or low-income countries. Unintentional injury rates in low- and middle-income countries are much higher than high-income countries (Hyder, Sugerman, Puvanachandra, El-Sayed, Isaza, Rahaman, & Peden, 2008; Schwebel, Swart, Simpson, Hui, & Hobe, 2009). Socioeconomic status and level of education play a role in the type of unintentional injuries encountered in low- and middle-income nations when compared to high-income nations (Schwebel, Swart, Simpson, Hui, & Hobe, 2009). For example, unintentional injuries encountered in high-income countries are most likely due traffic accidents involving either two motor vehicles, or a motor vehicle and a pedestrian. In high-income countries, Kuhlmann, Brett, Thoma and Saint (2009) noted that the public health sector encourages walking to school or work to increase physical activity. Although walking on the side of the road is beneficial for the health of an individual, it is also risky. Also, alcohol-related motor accidents are encountered more frequently in high-income countries than low-income countries (Kuhlmann, Brett, Thoma, & Sain, 2009). On the other hand, in low-income countries, unintentional injuries are typically caused by exposure to insecticide, burns from kerosene, near drowning, and a lack of supervision. It is important to note that even in high-income countries, poor children and adolescents still have the highest risk for unintentional injuries (WHO, 2010).
Prevention:
The intervention programs instituted to tackle and reduce the rate of unintentional injuries among children and adolescences differ from country to country. First, before an intervention is initiated, there should be an understanding of the causes of unintentional injuries in the community, including which groups of people are at risk; the intervention must be culturally specific (Bennett, 2010). The goal of public health is to reduce morbidity and mortality from unintentional injuries and, thus, before devising ways to overcome the challenges posed by unintentional injuries, it is important to first understand how the risks for unintentional injuries change as children get older. This approach will lead to a more effective intervention strategy (Prentice, 2009). Primary prevention focuses on being proactive, that is, taking action before the problem arises; it is aimed at populations rather than individuals (Cohen, Chavez, & Chehimi, 2007). For example, primary prevention encourages giving the right of way to pedestrians, establishing a minimum age for drinking, and wearing seat belts and helmets to reduce the rate of motor-related unintentional injury (WHO, 2008; Prentice, 2009). Secondary and tertiary prevention are intertwined in preventing unintentional injuries to children and adolescents. These involve education through community outreach programs to provide knowledge and skills, and creating environments to reduce road-related injuries. Both of these approaches have been associated with a decline in road-related unintentional injuries (Jones & Shults, 2009). In addition, the community or public health sector must provide adequate resources for troubled adolescents to address their concerns, rather than allowing them to engage in behavior that might lead to unintentional injury and death. The health promotion approach encourages the community to adopt health-related lifestyle changes, which will increase their control over their health and the factors that affect it (Bennett, 2010). However, in regards to low-income countries, the primary prevention, primary prevention has to be country-specific . Secondary and tertiary prevention might take a different approach depending on the issues that the country faces. For example, kerosene-related burns and poisoning are the most common causes of unintentional injuries in low-income countries of the Southern Africa region (Schwebel, Swart, Simpson, & Hui, 2009); thus, the primary, secondary and tertiary prevention will differ in this case.
Public Health Policy Implications
There is increasing evidence that public health policy needs to take the initiative to reduce, if not eliminate, all the factors that lead to unintentional injuries and death among children and adolescents (Sleet, Ballesteros, & Borse, 2010). Policies to protect individuals from work-related injuries, motor vehicle-related injuries, and home-related injuries are also essential. Many interventions, as extensive data have pointed out; have been directed at reducing mortality and morbidity caused by unintentional injuries. Many believe that these inventions will help promote healthy behavior among adolescents and children and ultimately reduce the incidence of unintentional injuries encountered. Sleet et al. (2010) asserts that unintentional injuries from drowning could be prevented if private or public swimming areas have the proper protecting devices. In addition, teenagers should discourage from any water sports while the under influence of alcohol. Similarly, since many unintentional injuries among children and adolescents are related to poisoning due to drug overdoses or inhalation of harmful substances, the proper disposal of medications at home or chemicals or farm products (for those living in rural areas), could help reduce resulting unintentional injuries.
According to Sleet el al (2010), many states are adopting programs such as the operational prescription monitoring program (PDMP). The intent of this program and others is to curtail drug-seeking behaviors. The PDMP encourages the use of electronics for prescribing drugs, which will help solve the problem. In the same way, unintentional injuries from chemical and gases need to be addressed. Many argue that the appropriate intervention will vary depending on if it is a developed or developing country. In developed countries, the use of smoke or carbon monoxide alarms, for example, have proven to be effective in reducing the number of unintentional injuries in workplaces, schools and homes. Also, the institution of poison control has been one of the many effective programs that exist in United States to help assist in the reduction of injuries related to poisons. (Sleet et al., 2010; WHO 2010). On the other hand, use of similar programs could benefit those in developing or rural areas; however, ensuring the availability of electrical power is an issue. Thus, the use of separate barns with locks to store any poisonous chemicals seemed more effective in dealing with poison control (WHO, 2010). Likewise, the use of smoke alarms in every habitable and sleeping area has been widely accepted as the best prevention technique and many experts believe that the proper installation and maintenance of such equipment will “ give children, adolescents and anyone experiencing a house fire sufficient warning to escape” ( Sleet et al. 2010). Although the use of smoke alarms will help reduce unintentional injuries, approximately 25% of installed smoke alarms do not function properly mainly due to un-replaced batteries.