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PEDIATRICS Vol. 112 No. 4 October 2003, pp. 931-938

Adolescent Assault Injury: Risk and Protective Factors and Locations of Contact for Intervention

Tina L. Cheng, MD, MPH^*,,, Donald Schwarz, MD, MPH^#, Ruth A. Brenner, MD, MPH^¶, Joseph L. Wright, MD, MPH^,,||, Cheryl B. Fields, MPH, Regina O’Donnell, BA, Peter Rhee, MD^** and Peter C. Scheidt, MD, MPH^¶

^* Department of General Pediatrics and Adolescent Medicine, Children’s National Medical Center, Washington, DC
Children’s Research Institute, Washington, DC
George Washington University School of Medicine, Washington, DC
^|| Department of Emergency Medicine, Children’s National Medical Center, Washington, DC
^¶ National Institutes of Child Health and Human Development, Bethesda, MD
^# Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
^** Department of Trauma Surgery, MedSTAR, Washington, DC

Background. Violence is a large contributor to morbidity and mortality among adolescents. Most studies assessing markers for violent injury are cross-sectional. To guide intervention, we conducted a case-control study to explore factors associated with assault injury and locations to reach at-risk adolescents.

Objective. 1) To assess risk and protective factors for adolescent assault injury compared with 2 control groups of youth with unintentional injuries and noninjury complaints presenting to the emergency department and 2) to assess locations of contact with assault-injured youth for prevention programs.

Methods. Face-to-face and phone interviews were conducted with systematic samples of youth aged 12 to 19 years presenting to the emergency department with assault injury, unintentional injury, and noninjury complaints. Youth with intentional injuries were matched to youth in the 2 control groups on age ±1 year, gender, race, and residency.

Results. One hundred forty-seven 147 assault-injured youth completed interviews. One hundred thirty-three assault-injured youth were matched to 133 unintentionally injured and 133 noninjured youth presenting to the emergency department. Compared with the 2 control groups, assault-injured youth were more likely to have had more fights in the past year (odds ratio [OR]: 3.91; 95% confidence interval [CI]: 2.02, 7.58; OR: 4.00; 95% CI: 2.23, 7.18) and fights requiring medical treatment (OR: 35.49; 95% CI: 8.71, 144.68; OR: 80.00; 95% CI: 11.13, 574.80). Eighty percent of assault-injured youth had been in 1 or more fights in the last 12 months compared with 55% and 46% in unintentional and noninjured controls, respectively. Assault-injured youth were more likely to have had previous weapon injuries (OR: 9.50; 95% CI: 3.39, 26.6; OR: 8.50; 95% CI: 3.02, 23.95) and have seen someone shot (OR: 2.00; 95% CI 1.12, 3.58; OR: 2.00; 95% CI: 1.12, 3.58). Eighty-six percent of assault-injured youth had a regular health care provider with 82% reporting a visit within the last year. There were no differences between cases and controls with regard to physician contact, extracurricular activity involvement, school or church attendance, police contact, weapon access or weapon-carrying, or witnessing nonweapon-related violence.

Conclusions. Fighting was common among all groups. Assault-injured youth were more likely to have had previous weapon injuries and were high-risk for future injury. Past fights, past fight injuries, and seeing someone else shot were markers associated with assault injury. Health providers do have access to at-risk teens for clinical risk assessment and intervention.

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Key Words: adolescent injury • violence • assault • case-control studies

Abbreviations: ED, emergency department

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Received for publication Jul 9, 2002; Accepted Nov 12, 2002.

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