title: Associations between adolescent risk behaviors and injury: the modifying role of disability.
abstract: BACKGROUND
  Adolescents with disabilities are at risk for poor health outcomes including injury. The objective of this study was to examine if disability status modifies the association between risk behavior and injury among adolescents.
  
  
  METHODS
  The cross-sectional Health Behavior in School-Aged Children Survey was administered to a representative sample of 7235 Canadian students (grades 6-10) in 2002. Students who reported at least 1 functional difficulty due to a health condition were classified as having a disability. Engagement in up to 6 individual risk behaviors and a summative multiple risk behavior score were considered the primary exposures. Primary outcomes included medically attended injury experienced during a 12-month period.
  
  
  RESULTS
  Sixteen percent of students reported a disability. Almost all risk behaviors and all injury outcomes were more common among students with disabilities than in those without disabilities (eg, older age group's smoking: 17.5% vs 8.9%, p = <.01; medically attended injury: 67.4% vs 51.4%, p = <.01). Clear risk gradients were observed between engagement in multiple risk behavior and all injury outcomes. The association between multiple risk behavior and injury was accentuated by disability status among older students, particularly for students with disabilities who engaged in frequent multiple risk behavior (adjusted risk ratio 1.8, 95% CI: 1.6-1.9).
  
  
  CONCLUSIONS
  Canadian students with disabilities who engage in risk behaviors experience higher risks for medically attended injury than their nondisabled peers who engage in those same risk behaviors. Injury prevention programs that focus on risk-taking behavior should integrate the needs of this high-risk group of adolescents in order to prevent additional disability.
authors.affiliation: Department of Community Health and Epidemiology, Queen's University, Kingston, Ontario, Canada K7L 3N6. ramans@email.unc.edu
authors.forename: Sudha R
authors.initials: SR
authors.lastname: Raman
authors.forename: William F
authors.initials: WF
authors.lastname: Boyce
authors.forename: William
authors.initials: W
authors.lastname: Pickett
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D002170:Canada / Q000453:epidemiology; D003430:Cross-Sectional Studies; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D009043:Motor Activity; D012309:Risk-Taking; D014947:Wounds and Injuries / Q000453:epidemiology*