title: Nonfatal injury incidence and risk factors among middle school students from four Polynesian countries: The Cook Islands, Niue, Samoa, and Tonga.
abstract: BACKGROUND
  The burden of injuries in Pacific Island countries is understudied despite the known challenges associated with many residents having limited access to advanced medical and surgical care when they sustain a serious injury. This paper examines nonfatal injuries among early adolescent schoolchildren (those primarily ages 13-15 years) from four Polynesian countries.
  
  
  METHODS
  Self-reported data from the 5507 middle school students who were randomly sampled for participation in the nationwide Global School-based Student Health Surveys (GSHS) in the Cook Islands (in the year 2009), Niue (2010), Samoa (2011), and Tonga (2010) were analysed with various statistical methods including regression models. Injuries were defined by the GSHS questionnaire as serious if they resulted in a full day of missed school or other usual activities or required medical treatment.
  
  
  RESULTS
  The proportion of students reporting a serious injury in the past year was 43.1% in the Cook Islands, 40.8% in Niue, 73.8% in Samoa, and 49.1% in Tonga. In the Cook Islands and Samoa, boys reported more injuries than girls (p<0.01). The most common types of serious injuries reported were cuts and other skin trauma; broken bones and dislocated joints; and concussions, other head injuries, or difficulty breathing. The most common causes of serious injuries reported were falls; motor vehicle accidents; and attacks, fights, or abuse. For both boys and girls, being bullied in the past month, being physically attacked or in a physical fight in the past year, using alcohol and tobacco, skipping school, and having anxiety or loneliness were associated with a higher likelihood of injuries.
  
  
  CONCLUSIONS
  School-based health education programs targeting prevention of intentional and unintentional injuries may benefit from emphasising Polynesian values and promoting personal mental and physical health, healthy behaviours, and healthy family and community relationships.
authors.affiliation: Department of Global & Community Health, George Mason University, 4400 University Drive 5B7, Fairfax, VA 22030, USA.
authors.forename: Vanessa C
authors.initials: VC
authors.lastname: Denny
authors.affiliation: Department of Global & Community Health, George Mason University, 4400 University Drive 5B7, Fairfax, VA 22030, USA.
authors.forename: James S
authors.initials: JS
authors.lastname: Cassese
authors.affiliation: Department of Global & Community Health, George Mason University, 4400 University Drive 5B7, Fairfax, VA 22030, USA. Electronic address: kjacobse@gmu.edu.
authors.forename: Kathryn H
authors.initials: KH
authors.lastname: Jacobsen
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control / Q000706:statistics & numerical data*; D000063:Accidents, Traffic / Q000517:prevention & control / Q000706:statistics & numerical data*; D000293:Adolescent; D002648:Child; D005260:Female; D006266:Health Education / Q000458:organization & administration; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D008297:Male; D010139:Pacific Islands / Q000453:epidemiology; D011114:Polynesia / Q000453:epidemiology; D012307:Risk Factors; D012572:School Health Services; D013334:Students; D014754:Violence / Q000517:prevention & control / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000517:prevention & control
keywords: Accidental falls; Adolescents; Cook Islands; GSHS; Injuries; Niue; Oceania; Pacific Islands; Samoa; Tonga