Published online December 1, 2005
PEDIATRICS Vol. 116 No. 6 December 2005, pp. e855-e863 (doi:10.1542/10.1542/peds.2005-0607)

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ELECTRONIC ARTICLE

Cross-national Study of Fighting and Weapon Carrying as Determinants of Adolescent Injury

William Pickett, PhD^*,, Wendy Craig, PhD, Yossi Harel, PhD^||, John Cunningham, BSc^*,, Kelly Simpson, MSc^*,, Michal Molcho, PhD^||, Joanna Mazur, PhD^¶, Suzanne Dostaler, MSc^*,, Mary D. Overpeck, DrPH^#, Candace E. Currie, PhD^** on behalf of the HBSC Violence and Injuries Writing Group

^* Community Health and Epidemiology
Emergency Medicine
Psychology, Queen’s University, Kingston, Ontario, Canada
^|| Department of Sociology and Anthropology, Bar-Illan University, Ramat Gam, Israel
^¶ Mother and Child National Research Institute, Warsaw, Poland
^# Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, Maryland
^** Child and Adolescent Health Research Unit, University of Edinburgh, Edinburgh, Scotland

Objectives. We sought to (1) compare estimates of the prevalence of fighting and weapon carrying among adolescent boys and girls in North American and European countries and (2) assess in adolescents from a subgroup of these countries comparative rates of weapon carrying and characteristics of fighting and injury outcomes, with a determination of the association between these indicators of violence and the occurrence of medically treated injury.

Design and Setting. Cross-sectional self-report surveys using 120 questions were obtained from nationally representative samples of 161082 students in 35 countries. In addition, optional factors were assessed within individual countries: characteristics of fighting (9 countries); characteristics of weapon carrying (7 countries); and medically treated injury (8 countries).

Participants. Participants included all consenting students in sampled classrooms (average age: 11–15 years).

Measures. The primary measures assessed included involvement in physical fights and the types of people involved; frequency and types of weapon carrying; and frequency and types of medically treated injury.

Results. Involvement in fighting varied across countries, ranging from 37% to 69% of the boys and 13% to 32% of the girls. Adolescents most often reported fighting with friends or relatives. Among adolescents reporting fights, fighting with total strangers varied from 16% to 53% of the boys and 5% to 16% of the girls. Involvement in weapon carrying ranged from 10% to 21% of the boys and 2% to 5% of the girls. Among youth reporting weapon carrying, those carrying handguns or other firearms ranged from 7% to 22% of the boys and 3% to 11% of the girls. In nearly all reporting countries, both physical fighting and weapon carrying were significantly associated with elevated risks for medically treated, multiple, and hospitalized injury events.

Conclusions. Fighting and weapon carrying are 2 common indicators of physical violence that are experienced by young people. Associations of fighting and weapon carrying with injury-related health outcomes are remarkably similar across countries. Violence is an important issue affecting the health of adolescents internationally.

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Key Words: adolescent • etiology • fighting • injury • trauma • violence • weapon carrying

Abbreviations: HBSC, Health Behaviour in School-Aged Children • OR, odds ratio

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Accepted Jun 23, 2005.

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