Injury PreventionViolent injuries among adolescents: Declining morbidity and mortality in an urban population*,**,★
Introduction
Adolescence is considered a critical developmental period of exploration, experimentation, and establishment of habits that may extend into adulthood. High rates of injury are associated with behavior patterns and risk factors common to adolescent development and include male sex, previous injuries, alcohol-drug use, conflict with parents, pattern of parent supervision, weapon carrying, delinquency, and pubertal development.1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13 Covarying risk factors for violent behavior are similar: male sex, poor mental health, drug use, lack of parental affection and support, weapon carrying, school dropout, exposure to violence, victimization, and delinquency.14, 15, 16, 17 The resulting morbidity and mortality during this developmental period of high violence, victimization, and initiation of serious violent behavior are of great national concern.18
In the United States, homicide is the third leading cause of death for adolescents 10 to 14 years old and the second cause of death for those 15 to 24 years old.19 For blacks, homicide is the leading cause of death for males and females 15 to 34 years old.20 Although the number of youth dying from violent injuries is alarming, it represents only a fraction of the injuries that occur in this age group. Nonfatal injury rates caused by violence, risky behavior, and failure to take safety precautions are higher for teenagers than for any other age group.21 Study of nonfatal or disabling injuries may provide guidance for development of prevention strategies.
In recent years, the adolescent homicide rate has decreased in urban and nonurban areas.22 The reasons behind the decline in mortality are unclear and have been postulated to include such factors as changing demographics, improved policing, more jailed offenders, maturing drug markets, greater safety consciousness, and a stronger economy.23, 24 Little information, however, is available on nonfatal injuries, which may offer clues to reasons behind the mortality decline. Has morbidity declined along with mortality? Are there specific causes of injury that have accounted for this decline? Has there been a decrease in injuries presenting for medical care related to unarmed and armed assault?
This surveillance study with 7 emergency departments in the District of Columbia, the Department of Health, and the Office of the Chief Medical Examiner explores the epidemiology of injuries in the 51,236 adolescents in the city in 1997.25 This study provides insight regarding the patterns of injuries among urban youth and trends over the recent past.
Section snippets
Materials and methods
An injury case was defined as an event of trauma, poisoning, or other injury caused by external factors occurring to a city resident 10 to 19 years of age that led to an ED visit, hospitalization, or death between June 15, 1996, and June 15, 1998. Residents who were imprisoned in neighboring facilities outside the city and college students in the city were included. Injury events were classified by using the International Classification of Diseases, ninth revision, Clinical Modification
Results
During the 2-year study, there were 15,190 injury events leading to ED visits or deaths among the adolescent population aged 10 to 19 years. US Census Bureau data indicates that the targeted population of 51,236 adolescents in the city in 1997 was 67% black,25 with an estimated 1995 median household income of $33,682.30 The event-based injury rate was 149 per 1,000 per year. For the 10- to 14-year-old group, the rate was 120 per 1,000 per year and rose to 177 per 1,000 per year for the 15- to
Discussion
A substantial number of adolescents experienced injury events requiring medical attention during the study time period, which is consistent with other studies that have estimated that one fifth to one fourth of children and adolescents in the United States experience an injury requiring medical attention each year.1, 32, 33, 34 Although unintentional injury accounts for most injury, the proportion of interpersonal intentional injuries in this population is similar to findings in other studies
Acknowledgements
We thank the members of the DC Child and Adolescent Injury Research Network for their support of this project. In addition, we gratefully acknowledge the significant contribution (trend analysis) of Kantilal M. Patel, PhD, Senior Statistician, Children's National Medical Center, Washington, DC.
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Cited by (29)
A Consensus-Driven Agenda for Emergency Medicine Firearm Injury Prevention Research
2017, Annals of Emergency MedicineCitation Excerpt :Longitudinal studies, including observational studies of at-risk ED populations, and outcome studies testing the efficacy of individual- and community-level interventions are necessary to advance the science of firearm violence prevention. Health care–based studies of peer violence have focused on understanding the epidemiology, health disparities, and individual-level risk factors associated with firearm-related assaults.88-93 Such studies have demonstrated, for instance, that among assault-injured youth seeking ED care, 25% have a firearm, with 80% of these firearms acquired through illegal channels.94
The Assault-Injured Youth and the Emergency Medical System: What Can We Do?
2013, Clinical Pediatric Emergency MedicineCitation Excerpt :Homicide rates do not tell the entire story, however; in 2011, almost 800 000 youth aged 15 to 24 years were cared for in an ED for injuries caused by violence, and 11% of these patients were hospitalized.12 In urban communities, interpersonal intentional injuries account for 25% of all youth injuries, 45% of hospitalizations, and 85% of injury deaths.13 However, children from all settings are vulnerable; one study found that 89% of students in a suburban school knew someone who had been robbed, beaten, stabbed, shot, or murdered, and 57% had witnessed such an event.
More than bike helmets and car seats: EDs step up role in pediatric injury prevention
2011, Annals of Emergency MedicineA prospective study of injuries inflicted on children by children
2010, Journal of Forensic and Legal MedicineCitation Excerpt :Most of these injuries appear to be relatively minor in nature, but a significant proportion were more serious, requiring admission to hospital and/or involving fractures causing pain and immobilisation with reduced function in the short and medium term. There is very little within the medical literature regarding interpersonal violence between children – much of what has been published has come from other parts of the world, with a focus upon serious injuries and deaths in older children and adolescents.6–10 One prospective study from the United States investigated the epidemiology of injuries to preschool children in care centres and found that 37% of injuries were precipitated by or had the involvement of another child.11
Training health professionals in Youth Violence Prevention: Overview of extant efforts
2005, American Journal of Preventive MedicineViolence: Concepts of its impact on children and youth
2003, Pediatric Clinics of North America
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Participants in the DC Child and Adolescent Injury Research Network include: Millicent Collins, MD, DC General Hospital; Melissa Clark, MD, Howard University Hospital; Peter Rhee, MD, Mark Smith, MD, Kristin Brandenburg, RNC, EMT, and Duncan Harviel, MD, Washington Hospital Center; Yolanda Haywood, MD, and B. Tilman Jolly, MD, George Washington University Medical Center; James Vafier, MD, Diane Sauter, MD, and Ira Mehlman, MD, Greater Southeast Community Hospital; Harinder Dhinsa, MD, Renee Reed, MD, and David P. Milzmann, MD, Georgetown University Hospital; Joseph Pestaner, MD, and Jacqueline Lee, MD, Chief Medical Examiner's Office; and Fern Johnson-Clarke, PhD, Department of Health, State Center for Health Statistics.
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Supported by the Centers for Disease Control and Prevention (R49/CCR311657-01) and the Robert Wood Johnson Foundation Generalist Faculty Scholars Program (Dr. Cheng).
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Address for reprints: Tina L. Cheng, MD, MPH, Department of General Pediatrics, Children's National Medical Center, 111 Michigan Avenue, NW, Washington, DC 20010;,202-884-5094, fax 202-884-3386; E-mail [email protected].