Associations between School-Behavior-Health Difficulties and Subsequent Injuries among Younger Adolescents: A Population-based Study

Abstract

Objective: School-behavior-health difficulties (SBHDs) may alter physical/mental capabilities and consequently increase injury risk during daily activities. This study assessed the associations of potential SBHDs and their cumulative number (SBHDcn) with various injury types among younger adolescents. Methods: The study population included 1,559 middle-school adolescents in France (10–18 years, 98% under 16,778 boys and 781 girls). They completed a questionnaire at school-year end collecting socioeconomic features (nationality, family structure, parents’ education/occupation/income), school/out-of-school injuries during the school-year (dependent variables), and SBHDs starting before the school-year (low academic performance, alcohol/tobacco/cannabis/other-illicit-drugs use, physical/verbal violence, sexual abuse, perpetrated violence, poor social support, poor general health status, sleep difficulty, depressive symptoms, and suicide attempt). Data were analyzed using logistic regression models and Kaplan–Meier estimates. Results: Injuries were frequent during school-physical/sports-training (10.9%), other-school-training (4.7%), school-free-time (7.4%), out-of-school-sports-activity (16.5%), and traffic (2.2%). Single injury (one injury all injury types combined) and ≥2 injury types affected 23.3 and 7.9% of subjects, respectively. The proportion of adolescents without SBHDs decreased with age more quickly among those with each injury type than among those without injury. Various SBHDs were associated with most injury types, single injury, and ≥2 injury types (sex-age-adjusted odds/relative-risk ratios reaching 11, p < .001). A dose–effect association was found between SBHDcn 1–2/3-5/≥6 and both single injury and ≥2 injury types (sex-age adjusted relative risk ratios reaching 12.66, p < .001, vs. SBHDcn = 0). Socioeconomic features had a moderate confounding role in these associations. Conclusions: SBHDs strongly predict injuries among adolescents. Our findings may inform healthcare providers about their prominent role in detecting/reducing SBHDs and injuries.

ARTICLE HIGHLIGHTS

• Various types of school and out-of-school injuries are common in younger adolescents.

• Most adolescents cumulate a wide range of school-behavior-health difficulties (SBHDs).

• Cumulating SBHDs is strongly associated with various injury types and repeated injuries.

• The risk remains strong when adjusting for socioeconomic features.

• Healthcare providers can detect/reduce SBHDs to limit their aggravation and injuries.

ACKNOWLEDGMENTS

The authors would like to thank the staff of the schools for their valuable help in the study. This research involved French national institute with public funds and did not received specific funds.

DISCLOSURE STATEMENT

No potential conflict of interest was reported by the author(s).

AUTHOR’S CONTRIBUTIONS

KC conceived and conducted the survey, performed the statistical analysis, and wrote the article. PP, GG, AB, AS, SB, FG, and BF participated in statistical analysis and writing of the paper. NC participated in conceiving the survey, statistical analysis, and writing of the paper. All authors read and approved the manuscript and its submission to the journal. The authors agree to the ICMJE statements.

ETHICAL APPROVALS

This study was approved by the Commission Nationale de l’Informatique et des Libertés (national review board, declaration number 1408688) and the regional education authority.

SUPPLEMENTARY DATA

Supplemental data for this article can be accessed online at https://doi.org/10.1080/00332747.2023.2238571

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This research involved French national institute with public funds.

Notes on contributors

Nearkasen Chau

Nearkasen Chau, PhD, is Research Director at the French National Institute for Health and Medical Research since 1978, unit 1178, Center of Epidemiology and Population Health, South-Paris and Paris Descartes Universities. Master in mathematics at the Royal University of Phnom-Penh (Cambodia).

Philippe Perrin

Philippe Perrin, MD, PhD, is Professor (exceptional class) at the Lorraine University (Physiology and Balance Control), physician in Oto-Laryngology at the University Hospital of Nancy (France) and sports physician. Head of the Laboratory Development, Adaptation and Handicap (EA 3450 DevAH) at the Lorraine University and of the Laboratory for the Analysis of Posture, Equilibrium and Motor Function (LAPEM) at the University Hospital.

Gérome Gauchard

Gérome Gauchard, PhD, is Professor of Biomechanics and Neuroscience (exceptional class) at the Faculty of Sports Sciences of Nancy, University of Lorraine, responsible of the research axis “Exercise, Training, Performance” of the Laboratory Development, Adaptation and Handicap (EA 3450 DevAH). He is head of the CARE Grand Est (Centre for Support, Research & Expertise) for the innovation in sports and health.

Ashis Bhattacherjee

Ashis Bhattacherjee, PhD, is Professor at the Department of Mining Engineering and joint faculty of the CoE SEA of Indian Institute of Technology Kharagpur. He was the Head of the Department of Mining Engineering during 2003–2006.

Amrites Senapati

Amrites Senapati is a Senior Research Fellow at the Department of Mining Engineering, Indian Institute of Technology Kharagpur.

Slimane Belbraouet

Slimane Belbraouet, PhD (University of Lorraine Nancy, France, 1994) is Professor starting his academic career in 1980 at the University of Sidi Bel abbes (Algeria) and is currently a full professor in the School of Nutrition at the University of Moncton (Canada) teaching both undergraduate and graduate levels in nutrition.

Francis Guillemin

Francis Guillemin, MD, PhD, is Professor at the Lorraine University. His research areas include measurement of perceived health, where he has developed several indicators, proposed new methods for cross-cultural adaptation, and applied modern psychometry theories.

Bruno Falissard

Bruno Falissard, MD, PhD, after initial training in mathematics and fundamental physics (Ecole Polytechnique, Paris), engaged in medical studies and specialized in Child/Adolescent Psychiatry in 1991.

Kénora Chau

Kénora Chau, MD, PhD, is Assistant Professor of General Medicine at the Lorraine University and INSERM Unit 1433, Nancy, France.