title: Higher education does not protect against firework-related injuries: a review of the economic burden and the risk factors of firework-related injuries in the capital of Iran.
abstract: OBJECTIVE
  To examine the incidence and risk factors of firework-related injuries during the Last Wednesday Eve Festival in Tehran, Iran, with a focus on the association of socio-economic status and educational level with the use of fireworks and the incidence of firework-related injury.
  
  
  METHODS
  Cross-sectional household survey.
  
  
  METHODS
  Using a random cluster sampling approach, a household survey was conducted in Greater Tehran in April 2008. During a structured interview with an adult member of the household, questions were asked about the use of fireworks and any firework-related injuries sustained by household members during the preceding festival. Data were gathered on expenditure on fireworks, medical treatment of firework-related injuries, length of hospital stay for the treatment of these injuries, and damage to personal property by fireworks.
  
  
  RESULTS
  The survey included 2456 households in Greater Tehran. At least one member of 18% of these households had used fireworks during the Last Wednesday Eve Festival in 2008. The overall incidence of firework-related injuries was 100 per 100,000 population (95% confidence interval 37-163). The use of fireworks was less common among parents and more common among male children. Individuals who used fireworks were younger than non-users. Younger age and use of fireworks were associated with firework-related injuries (P < 0.05). The mean household expenditure on fireworks was US$1.62. Among the households that had bought fireworks, the mean expenditure was US$9.40 (standard deviation US$16.34). Thirty-two households (1.3%) reported damage to personal property due to fireworks during the festival costing US$3.30-167.20. The regional price of housing in the study area was correlated with the educational level of the head of the household. Higher educational level of the head of the household was associated with participation in firework activities by household members, expenditure on fireworks, and the amount of financial loss due to fireworks (all P < 0.05).
  
  
  CONCLUSIONS
  Fireworks are associated with serious injuries, and impose a non-trivial financial burden on families. While personal use of fireworks was an independent risk factor for firework-related injuries, higher socio-economic status of the household and higher educational level of the head of the household were not protective factors.
authors.affiliation: Sina Trauma and Surgery Research Centre, Tehran University of Medical Sciences, Sina Hospital, Emam Khomeini Avenue, P.O. Box 11155/3876, Tehran, Iran. soheil.saadat@gmail.com
authors.forename: S
authors.initials: S
authors.lastname: Saadat
authors.forename: M
authors.initials: M
authors.lastname: Mafi
authors.forename: G A
authors.initials: GA
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D000328:Adult; D001753:Blast Injuries / Q000191:economics / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D004522:Educational Status; D005107:Explosions / Q000191:economics / Q000706:statistics & numerical data*; D005191:Family Characteristics; D005260:Female; D006693:Holidays; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007492:Iran / Q000453:epidemiology; D008297:Male; D012307:Risk Factors; D012923:Social Class; D055815:Young Adult