Injury Risk-Taking Behaviors in Children

by

Marizen Ramirez, Elizabeth O'Neal

• LAST REVIEWED: 13 December 2022
• LAST MODIFIED: 30 September 2013
• DOI: 10.1093/obo/9780199756797-0134

Introduction

Unintentional injury is among the leading causes of morbidity and mortality across the world, and for children ages one to eighteen is their number-one killer. To inform the development of effective prevention strategies for children, public health research uses two frameworks for identifying causal pathways to injury. One approach, the epidemiologic triangle, involves identification of host, environmental, and agent (in the case of traumatic injury, the agent is energy; in the case of drowning, the agent is lack of oxygen; in the case of poisoning, the agent is a toxic substance) characteristics that increase risk of childhood injury. The second approach, the Haddon Matrix, builds on the epidemiologic triangle and identifies specific host, environmental, and agent factors that operate during pre-injury (prior to an injury occurring), injury (at the moment of injury), and post-injury phases. Both the epidemiologic triangle and the Haddon Matrix emphasize the complex interplay that occurs between host, environment, and agent, and demonstrate that these factors are not easily separable. Decades of research from epidemiology, behavioral health, and psychology have established that human/host behavior, specifically injury risk behaviors, contributes significantly to injury causation. Injury risk behaviors are defined broadly as classes or groups of actions taken on by the host (in this case, children) that increase the probability of injury, either directly or in synergistic interaction with the environment. This section highlights primarily empirical research on unintentional injury risk behaviors in children (generally within the age range of one to eighteen), methods used to measure and study injury risk behaviors, factors that influence behavior, and discrete behaviors (e.g., risky driving) associated with specific injury outcomes (e.g., traffic crashes). Selected works that deal with children older than eighteen are also presented to provide broader concepts with strong applicability to pediatric injury.

General Overviews

For an overview of the broad topic of unintentional injuries in Oxford Bibliographies, see Unintentional Injury Prevention by David Sleet. Four pertinent reviews have been published on the topic of injury risk behaviors, and these present the foundational studies establishing empirical associations between childhood behaviors and injuries. Three of these reviews focus on children (Irwin, et al. 1992; Wazana 1997; Schwebel and Gaines 2007). Irwin, et al. 1992 provides the motivations behind studying pediatric injury risk behaviors, summarizes key research studies, and highlights theory and methods used in the field. Wazana 1997 is a systematic review of the literature to identify epidemiologic studies from Australia, Canada, New Zealand, the United Kingdom, and the United States on general child injury and child pedestrian injury (ages one to sixteen). Schwebel and Gaines 2007 summarizes conceptual approaches and key findings from research highlighting behavioral risk factors for injury, including studies describing demographic characteristics; child-based factors such as temperament, personality, and cognitive development; parent-based behaviors; and peer behaviors. Because of the limited rigorous literature on the topic, readers are also referred to a broad systematic review in Turner, et al. 2004 of case-control and cohort studies on behaviors associated with injury not limited to children.

• Irwin, C. E., M. F. Cataldo, A. P. Matheny Jr., and L. Peterson. 1992. Health consequences of behaviors: Injury as a model. Pediatrics 90.5: 798–807.

  Describes the public health problem of pediatric injury, from research conducted thus far. Emphasizes the need for interventions that focus on reduction of injury risk behaviors, describing the motivations for behavioral research informed by developmental-psychosocial theory. Key studies of injury risk behaviors in children up to age twenty-four and methodological approaches are summarized. Available online for purchase or by subscription.

• Schwebel, D. C., and J. Gaines. 2007. Pediatric unintentional injury: Behavioral risk factors and implications for prevention. Journal of Developmental & Behavioral Pediatrics 28.3: 245–254.

  DOI: 10.1097/01.DBP.0000268561.80204.2a

  A systematic review of the available literature on contributions to injury risk, specifically in children. This comprehensive introduction to behavioral risk factors of unintentional injury considers four main areas of injury risk: demographic, child-specific, parent and caregiver influence, and peer influence. Also briefly considers intervention. Available online for purchase or by subscription.

• Turner, C., R. McClure, and S. Pirozzo. 2004. Injury and risk-taking behavior—a systematic review. Accident Analysis & Prevention 36.1: 93–101.

  DOI: 10.1016/S0001-4575(02)00131-8

  Reviews seven epidemiological studies (case-control, cohort, or intervention) on risk-taking behaviors, where researchers objectively measure injury and risk taking, thus highlighting a critical methodological consideration of measurement. One study reviewed was on young drivers from the United States between sixteen and nineteen years of age. Available online for purchase or by subscription.

• Wazana, A. 1997. Are there injury-prone children? A critical review of the literature. Canadian Journal of Psychiatry 42.6: 602–610.

  A literature review of eleven studies of general pediatric injury and six childhood pedestrian injury that specifically examine behavioral risk factors in children ages one to sixteen. Review includes works from Australia, Canada, New Zealand, the United Kingdom, and the United States. Describes some history of research on injury-prone children. Also included are studies of emotional factors associated with injury.