title: Multiple risk behavior and injury: an international analysis of young people.
abstract: BACKGROUND
  Multiple risk behavior plays an important role in the social etiology of youth injury, yet the consistency of this observation has not been examined multinationally.
  
  
  OBJECTIVE
  To examine reports from young people in 12 countries, by country, age group, sex, and injury type, to quantify the strength and consistency of this association.
  
  
  METHODS
  World Health Organization collaborative cross-national survey of health behavior in school-aged children.
  
  
  METHODS
  A multinational representative sample of 49 461 students aged 11, 13, and 15 years.
  
  
  METHODS
  Additive score consisting of counts of self-reported health risk behaviors: smoking, drinking, nonuse of seat belts, bullying, excess time with friends, alienation at school and from parents, truancy, and an unusually poor diet.
  
  
  METHODS
  Self-report of a medically treated injury.
  
  
  RESULTS
  Strong gradients in risk for injury were observed according to the numbers of risk behaviors reported. Overall, youth reporting the largest number (> or =5 health risk behaviors) experienced injury rates that were 2.46 times higher (95% confidence interval, 2.27-2.67) than those reporting no risk behaviors (adjusted odds ratios for 0 to > or =5 reported behaviors: 1.00, 1.22, 1.48, 1.73, 1.98, and 2.46, respectively; P<.001 for trend). Similar gradients in risk for injury were observed among youth in all 12 countries and within all demographic subgroups. Risk gradients were especially pronounced for nonsports, fighting-related, and severe injuries.
  
  
  CONCLUSIONS
  Gradients in risk for youth injury increased in association with numbers of risk behaviors reported in every country examined. This cross-cultural finding indicates that the issue of multiple risk behavior, as assessed via an additive score, merits attention as an etiological construct. This concept may be useful in future injury control research and prevention efforts conducted among populations of young people.
authors.affiliation: Department of Community Health and Epidemiology, Queen's University, Kingston, Ontario, Canada K7L 2V7. PickettW@post.queensu.ca
authors.forename: William
authors.initials: W
authors.lastname: Pickett
authors.forename: Holger
authors.initials: H
authors.lastname: Schmid
authors.forename: William F
authors.initials: WF
authors.lastname: Boyce
authors.forename: Kelly
authors.initials: K
authors.lastname: Simpson
authors.forename: Peter C
authors.initials: PC
authors.lastname: Scheidt
authors.forename: Joanna
authors.initials: J
authors.lastname: Mazur
authors.forename: Michal
authors.initials: M
authors.lastname: Molcho
authors.forename: Matthew A
authors.initials: MA
authors.lastname: King
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Godeau
authors.forename: Mary
authors.initials: M
authors.lastname: Overpeck
authors.forename: Anna
authors.initials: A
authors.lastname: Aszmann
authors.forename: Monika
authors.initials: M
authors.lastname: Szabo
authors.forename: Yossi
authors.initials: Y
authors.lastname: Harel
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D002648:Child; D002652:Child Behavior; D016000:Cluster Analysis; D005260:Female; D006801:Humans; D008297:Male; D012309:Risk-Taking; D011795:Surveys and Questionnaires; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000209:etiology