Factors associated with injuries in adolescents, from the National Adolescent School-based Health Survey (PeNSE 2012)

Malta, Deborah Carvalho; Prado, Rogério Ruscitto do; Caribe, Silvania Suely Andrade; da Silva, Marta Maria Alves; de Andreazzi, Marco Antonio Ratzsch; Júnior, Jarbas Barbosa da Silva; Minayo, Maria Cecilia de Souza · 2014 · DOAJ

DOI: 10.1590/1809-4503201400050015

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Summary

This study investigates the prevalence of serious injuries among Brazilian adolescents and identifies associated risk factors, addressing a gap in national data regarding injury determinants. Motivated by the high global morbidity and mortality rates linked to injuries in youth, particularly in low- and mid-income countries, the research aims to analyze how sociodemographic characteristics, individual behaviors, family dynamics, mental health, and exposure to violence contribute to injury occurrence. The study utilizes data from the 2012 National Adolescent School-based Health Survey (PeNSE), providing a comprehensive view of injury patterns among school-aged youth in Brazil. The methodology employed a complex cluster sampling design involving 109,104 ninth-grade students from public and private schools across Brazil. The primary outcome was self-reported serious injury (e.g., broken bones, cuts, perforations) within the past 12 months. Researchers conducted bivariate analyses using odds ratios (OR) and subsequently applied a multivariate hierarchical model to identify independent associations, retaining variables with a p-value < 0.05. The model categorized explanatory variables into five blocks: sociodemographic aspects, individual risk/protective factors, mental health, family context, and contextual violence factors. Statistical adjustments were made for sampling weights to ensure representative estimates. The results indicate that 10.3% of adolescents suffered serious injuries in the previous year, with falls being the most common cause (44%). In the final adjusted model, several factors remained independently associated with increased injury risk. Sociodemographically, being male, identifying as black, mulatto, or indigenous, and engaging in child labor significantly increased risk. Individual behavioral risks included regular tobacco use, alcohol consumption, illicit drug experimentation, and early sexual intercourse. Mental health issues, specifically insomnia and feelings of loneliness, were also significant predictors. Regarding family context, adolescents who experienced physical assault from family members, skipped school without parental notification, or did not live with their parents faced higher risks, whereas parental supervision served as a protective factor. Exposure to violence and unsafe environments, including insecurity at school or during commutes, being bullied, riding with intoxicated drivers, driving motorized vehicles, and failing to use seatbelts or helmets, were all strongly associated with injury occurrence. The study concludes that adolescent injuries are determined by a complex interplay of social, familial, and behavioral factors, highlighting significant social inequalities. The findings underscore the need for multifaceted public health interventions that go beyond individual behavior modification. Effective prevention strategies must address structural issues such as social inequality, strengthen family ties and supervision, mitigate violent contexts in schools and communities, and promote safety behaviors like seatbelt and helmet use. This research provides critical evidence for policymakers to design comprehensive programs aimed at reducing injury prevalence among Brazilian youth.

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• demographic disparities