What is the evidence to prevent injury among adolescents?

By Dr Amy Peden, School of Population Health, UNSW Sydney (Twitter: @amyepeden)

Injury is a leading cause of death and disability among adolescents, yet investment in these preventable harms lag behind that of other issues and investments made in younger children. A study we recently completed in the Lancet Public Health used Global Burden of Disease Study data to highlight this burden.

We found the proportion of adolescent deaths and disability adjusted life years (or DALYs) attributed to transport and unintentional injuries such as drowning, falls, burns and poisoning, has barely shifted in three decades. Transport and unintentional injuries caused 369,000 deaths and 31.1 million DALYs in adolescents 10-24 years in 2019, indicating an urgent need for primary prevention to reduce risk and save lives.

So why do we see continually high injury burden among adolescents, particularly in low- and middle-income countries? Is there no evidence to support investment in effective interventions? This is the research question we set out to answer in a systematic review of literature recently published in the Journal of Safety Research.

Between 2010 and 2022, we identified 62 studies which evaluated the effectiveness of interventions for the primary prevention of transport or unintentional injuries specifically for adolescents 10-24 years. We identified some strong areas of evidence to inform investment in injury prevention, but concerningly, some major gaps.

There is strong evidence to support injury prevention in high burden but low lethality sport injuries (36 studies or 58% of all studies). Effective interventions include neuromuscular training (often focused on soccer-related injuries), rule changes and protective equipment.

Given the high burden of transport injuries, its was pleasing to identify 21 studies (34% of all included studies) reporting prevention of road traffic injury, with legislative approaches (commonly graduated driver licensing schemes like we have in Australia), found to be effective in reducing fatal and nonfatal road traffic injury.

But concerningly, only 3 studies (just 4.8% of all included studies) evaluated adolescent transport or unintentional injury prevention interventions in a low-and middle-income context, despite adolescents in such countries experiencing much of the burden of injury-related harms.

In a further example of bias, 61% of studies were rated as having no consideration of discussion of equity. While age and gender were common equity-related variables reported, there was little consideration of other factors such as education, socio-economic position, disability, sexual orientation or race/ethnicity. No studies evaluated injury prevention interventions for First Nations adolescents.

Seven studies reported interventions for other unintentional injuries (e.g., falls). However none of these examined the prevention of drowning, the second leading cause of injury-related death among adolescents.

In order to support donor and government investment in injury prevention intervention for adolescents, there needs to be high quality evidence to support this decision. Our research is supporting the Driving Global Investment in Adolescent Health Centre of Research Excellence’s aim to do just this. It’s time we all #InvestInYouth and address these preventable causes of death and disability.

You can read the full study here: https://www.sciencedirect.com/science/article/pii/S0022437523000385?via%3Dihub