Published online November 1, 2006
PEDIATRICS Vol. 118 No. 5 November 2006, pp. e1342-e1349 (doi:10.1542/peds.2006-0834)
This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Yard, E. E.
Right arrow Articles by Comstock, R. D.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Yard, E. E.
Right arrow Articles by Comstock, R. D.
Related Collections
Right arrow Office Practice
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Facebook   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?

ARTICLE

Illness and Injury Among Children Attending Summer Camp in the United States, 2005

Ellen E. Yard, MPHa, Margery M. Scanlin, EdDb, Linda Ebner Erceg, RN, MS, PHNc,d, Gwynn M. Powell, PhDe, John R. Wilkins, III, BCE, DrPHf, Christy L. Knox, MAa and R. Dawn Comstock, PhDa,f,g

a Center for Injury Research and Policy, Columbus Children's Research Institute, Children's Hospital, Columbus, Ohio
b American Camp Association, Research and Intellectual Resources, Martinsville, Indiana
c Association of Camp Nurses, Bemidji, Minnesota
d Concordia Language Villages, Bemidji, Minnesota
e Department of Recreation and Leisure Studies, College of Education, University of Georgia, Athens, Georgia
f Division of Epidemiology, School of Public Health
g Department of Pediatrics, College of Medicine, Ohio State University, Columbus, Ohio


   ABSTRACT
TOP
 ABSTRACT
METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
OBJECTIVES. The purpose of this work was to describe illnesses and injuries sustained by campers at summer camps, calculate illness and injury rates, and identify risk factors for camp-related illness and injury.

METHODS. A convenience sample of camps selected from the US summer camp population participated in this pilot illness and injury surveillance study. Camps completed weekly reports detailing the number of campers on site and the number of adverse events sustained and provided specific information about each adverse event.

RESULTS. A total of 177 camper illnesses and injuries occurred during 122379 camper-days, with a median rate of 1.15 adverse events per 1000 camper-days. The majority of reported events were illnesses (68.0%), 11.8% of which were communicable and seen in multiple individuals at camp. Of the injury events (32.0%), cut/scratch/scrape were the most common diagnoses (33.3%), followed by fracture (14.6%) and sprain/strain (10.4%); horseback riding and capture the flag were identified as injury-producing activities.

CONCLUSIONS. Internet- and telephone-based surveillance systems can be successfully used to conduct illness and injury surveillance among children attending summer camp. Data collected via such systems can be used to calculate illness and injury rates, to describe patterns of illness and injury, and to identify risk factors for camper-related illness and injury. Given the millions of children attending summer camp yearly, a surveillance system such as this can provide the data needed to develop evidence-based prevention interventions to decrease the number of youth whose camp experiences are negatively affected by illness and injury.

Key Words: summer camp • illness • injury • surveillance and monitoring • children and adolescents

Abbreviations: ACA—American Camp Association • RR—relative risk • CI—confidence interval

Attending summer camp has been a tradition for US youth for >140 years.1 In 2002, >11 million children and adults attended one of the ~12000 US summer camps.2 In a recent American Camp Association (ACA) survey of >5000 campers, their parents, and camp staff, all 3 of the groups indicated that camp enabled the participant to make new friends, meet kids who are different from themselves, gain self-confidence, and participate in a variety of new activities.3

Unfortunately, these opportunities can inadvertently expose children to risk factors for illness and injury (adverse events). Recent youth development research revealed that in addition to the cost of camp, physical and emotional safety was a high priority for parents, ranking as high as positive and fun activities.2 The first step toward addressing such concerns is the collection of accurate illness and injury data, which will allow researchers to identify and address associated risk factors. In conjunction with high supervision ratios by trained adults, learning as much as possible from such data collection can help provide safer environments that everyone can benefit from.

The majority of previously published research related to summer camp health issues focused on outbreak investigations4–11 or investigations of the specific needs of ill children attending specialty camps, such as asthma camp,12 burn camp,13 or cancer camp.14 Unfortunately, such publications offer little assistance to camp health officers hoping to reduce camper adverse event incidence and severity through improved health services and prevention strategies. Early epidemiological descriptions tended to center on either illnesses or injuries and were often simple reviews of camp health center records.15–23 More recent surveillance studies had limitations, including short follow-up periods and small sample sizes.24–27

Despite such limitations, these studies demonstrate that epidemiological evaluation of adverse events among campers can be used to describe illness and injury patterns, identify risk factors, and develop and evaluate preventive programs aimed at reducing such events to their lowest possible level. This pilot study represents the first step toward the implementation of a long-term illness and injury surveillance program in a sample of US summer camps. The aims were: (1) to collect accurate summer camp exposure data for campers, (2) to collect accurate illness and injury incidence data for campers, (3) to collect detailed information about each illness and injury event, (4) to calculate illness and injury rates, and (5) to identify risk factors for camper-related illness and injury.


   METHODS
TOP
 ABSTRACT
 METHODS
RESULTS
 DISCUSSION
 REFERENCES
 
Illness, Injury, and Exposure Definition
Reportable adverse events had to meet all 3 of the following criteria: (1) an illness or injury that occurred during a camper's (≤18 years of age) participation in the camp program, whether at camp or during an off-site camp activity (eg, canoeing); (2) an illness or injury for which the camper required medical attention; and (3) an illness or injury that removed and/or restricted the camper from their normal camp routine for ≥4 hours. Weekly camper exposure was calculated by summing the number of campers present each day of the week. For example, if there were 50 campers on site all 7 days, then the weekly camper exposure was 350 camper-days.

Data Source and Sample Design
A convenience sample drawn from the >2300 ACA accredited and affiliated summer camps was used for pilot study participation. Information about the proposed study, including a contact for interested camps to request additional details, was distributed throughout the camping community through several means. These included an article in Camping Magazine available online through the ACA Web site (www.ACAcamps.org/InsideACA), advertisement on the Association of Camp Nurses Web site (www.campnurse.org), presentations at camp conventions and meetings (including the Ohio Section Annual Conference in January 2005, the ACA National Conference in Florida in February 2005, the Tri-State Camping Conference in New York in March 2005, and the Mid-States Camping Conference in Illinois in April 2005), and through word of mouth. Summer camps expressing interest in participating were asked to complete a survey used to assign them to the appropriate stratum of a sampling frame designed to reflect the diversity of US summer camps (eg, day or resident camp and type of camp sponsorship). A sample of interested camps was selected from each sampling frame in an attempt to capture as representative a sample of summer camps as possible.

Selected camps (n = 28) were given a unique study identification number and were assigned randomly to report via either an Internet- or telephone-based surveillance system, both of which were developed specifically for this pilot project. These camps represented 14 states. Each participating camp designated a reporter to be responsible for reporting data weekly throughout the 10-week study period running from June 1, 2005, through August 10, 2005. Reporters, in order of desirability, included camp nurses, physicians, emergency medical technicians, individuals trained in first aid, and camp directors.

Data Collection
The Internet and telephone surveillance systems (Camp RIO [Reporting Information Online] and the Dr GOOP telephone system, respectively) both collected the same information: camper exposure data, illness and injury incidence data, and detailed information about each illness and injury reported. Each reporter was asked to complete a weekly exposure report listing the number of campers on site along with the number of adverse events that met the study definition for each week of the study, even if their camp was not in session or if no illnesses or injuries occurred. In addition, for each adverse event, reporters completed an illness or injury report form that compiled detailed information about the camper experiencing the adverse event (age, gender, location/housing, etc), information about the illness (signs, symptoms, severity, etc) or injury (body site, injury type, severity, etc), and information about the circumstances associated with the event (date and time of onset, camp activity, involvement of vectors, use of protective equipment, etc). Reporters were given the opportunity to update reports throughout the study.

Statistical Analysis
Data analysis was conducted using SPSS version 13.0 (SPSS, Chicago, IL) and Epi Info version 6 (Centers for Disease Control and Prevention, Atlanta, GA). Adverse event, illness, and injury rates were calculated for each camp, with the summary statistics presented here (median, 15th percentile, 85th percentile, and maximum). For categorical variables, differences were analyzed using relative risks with 95% confidence intervals and {chi}2 tests based on a simple random sample; P < .05 was considered significant. The institutional review board at Columbus Children’s Research Institute approved this study.


   RESULTS
TOP
 ABSTRACT
 METHODS
 RESULTS
DISCUSSION
 REFERENCES
 
Reporter Compliance
Of the 28 camps asked to report each week of the 10-week study, 25 camps reported information to the surveillance system at least once, with 10 camps reporting via telephone and 15 via Internet. These camps completed 196 (78.4%) of the expected 250 weekly exposure reports (25 camps reporting for 10 weeks) for an average of 7.8 completed weekly exposure reports per week. The majority of participating telephone and Internet camps (70.0% and 73.3%, respectively) were resident camps (camps where campers remain at camp around the clock), with the remainder consisting of day camps (camps where campers stay only for the day, returning home each evening). These percentages reflect the underlying distribution of ACA-accredited resident (63%) and day camps (37%).3

The majority of reporters were nurses (n = 12 camps), followed in frequency by individuals trained in first aid (n = 7 camps), emergency medical technicians (n = 3 camps), camp directors (n = 2 camps), and 1 adult in an unidentified role. Camp health care personnel (59.0%) and offsite physicians (25.6%) diagnosed the majority of reported illnesses and injuries.

Adverse Event Rate
Overall, a total of 177 camper illnesses and injuries occurred during 122379 camper-days. The median camp adverse event rate was 1.15 per 1000 camper-days (15th percentile: 0 per 1000 camper-days; 85th percentile: 4.05 per 1000 camper-days; maximum: 7.95 per 1000 camper-days). The adverse event rate was higher among resident camps (median: 1.50 per 1000 camper-days; 15th percentile: 0.35 per 1000 days; 85th percentile: 5.84 per 1000 camper-days; maximum: 7.95 per 1000 camper-days) compared with day camps (median: 0.21 per 1000 camper-days; 15th percentile: 0 per 1000 camper-days; 85th percentile: 1.78 per 1000 camper-days; maximum: 1.78 per 1000 camper-days).

Of the 177 adverse events reported on the weekly exposure reports, there were 156 (88.1%) illness or injury report forms completed. Six of these were removed, because the camper was >18 years of age. Of these remaining 150 adverse event reports, 102 (68.0%) were illnesses, and 48 (32.0%) were injuries. Resident camps accounted for 126 (84.0%) of the adverse events, with the majority of these campers sustaining illnesses (n = 90; 71.4%). Day camps accounted for 24 (16.0%) of the adverse events, with campers sustaining illnesses (n = 12; 50.0%) and injuries (n = 12; 50.0%) similarly. The illness rate (median: 0.82 per 1000 camper-days; 15th percentile: 0 per 1000 camper-days; 85th percentile: 2.25 per 1000 camper-days; maximum: 4.55 per 1000 camper-days) was higher than the injury rate (median: 0.07 per 1000 camper-days; 15th percentile: 0 per 1000 camper-days; 85th percentile: 0.97 per 1000 camper-days; maximum: 1.44 per 1000 camper-days).

Demographic Characteristics of Ill or Injured Campers
Resident and day camp data were aggregated for analyses. Demographic characteristics of reported camper adverse events are presented in Table 1. The average age of campers sustaining an adverse event was 11.7 years. They tended to be resident rather than day campers, to have been at camp for ≥2 days before the adverse event, and to be participating in an onsite camp activity when the event occurred. In addition, adverse events occurred primarily after noon (61.1%) and were more common on Mondays, Tuesdays, and Wednesdays (63.6%). Although most of the ill or injured campers were treated onsite or released after treatment at an offsite facility (eg, doctor's office, emergency department, or outpatient clinic), 5.3% were admitted for treatment at an offsite facility. Of all of the campers sustaining adverse events, 22.1% left camp after the incident and did not return.


View this table:
[in this window]
[in a new window]

  		TABLE 1 Characteristics of Campers Sustaining Illness and Injury in the United States, 2005

 
The average age, gender, residence status (day versus overnight), length of time spent at camp before adverse event occurrence, time of adverse event occurrence, and final camper disposition were similar between campers sustaining illnesses and campers sustaining injuries. Campers sustaining an injury (79.2%) were more likely to be participating in a camp activity at the time of the event than campers sustaining an illness (54.5%; RR = 1.45; 95% confidence interval [CI]: 1.16–1.83; P = .006). Injuries (87.5%) were more likely than illnesses (22.5%) to require offsite medical attention (RR = 3.88; 95% CI: 2.67–5.65; P < .001). Although injured campers (14.6%) tended to be located off camp property when the adverse event occurred more often then ill campers (5.0%; RR = 2.95; 95% CI: 0.99–8.81; P = .090), this difference was insignificant.

Illness Characteristics
Figure 1 presents the most commonly reported body sites and symptoms involved in the 102 reported camper illnesses. Reporters were allowed to list multiple body sites and symptoms for each illness. The most commonly involved body sites were the gastrointestinal system (43.1%) and the throat (17.6%). Headache (29.4%), nausea (27.5%), and fever (27.5%) were the most commonly reported symptoms. The majority of illnesses were new (n = 76; 74.5%) and noncommunicable (n = 65; 63.7%). However, 12 (11.8%) were communicable illnesses that were related to illness among others at camp. Complications of chronic diseases (eg, asthma and diabetes) accounted for 11 (10.8%) events. Mondays (n = 22; 21.8%), Tuesdays (n = 23; 22.8%), and Wednesdays (n = 21; 20.8%) were the most common days for illness onset.


Figure 1
View larger version (22K):
[in this window]
[in a new window]

  		FIGURE 1 Description of camper illness. A, Body sites affected by illness. B, Symptoms of illness (multiple responses were allowed, thus, frequencies do not sum to 102).

 
Illness diagnosis was an open-ended question. Reported communicable illnesses that were related to illnesses in others at camp included head lice, conjunctivitis, and viral infection. The "stomach flu," a set of symptoms that can be caused by a variety of organisms, was also cited. Illnesses that resulted in the camper leaving camp (n = 20) included viral infection, high fever, food poisoning, streptococcal pharyngitis, conjunctivitis, influenza, dehydration, acute otitis media with mastoid area cellulitis, an allergic reaction to pool chlorine, Lyme disease, a urinary tract infection, a complication of sickle cell, and homesickness.

Injury Characteristics
Figure 2 presents the body site, diagnosis, and mechanism of the 48 reported camper injuries. Reporters were allowed to list only 1 body site, mechanism, and diagnosis for each injury. The head and face (head, eye, ear, nose, face, chin, jaw, mouth, teeth, and tongue) were injured most often (29.2%), followed by the upper extremities (shoulder, clavicle, upper arm, elbow, lower arm, wrist, hand, and finger; 25.0%) and lower extremities (hip, upper leg, knee, lower leg, ankle, foot, and toe; 25.0%). Cut/scratch/scrape injuries were the most common diagnoses (33.3%), followed by fracture (14.6%) and sprain/strain (10.4%). Cut/scratch/scrapes were most common to the eye (n = 4), followed by the chin (n = 3), the head and face (each with n = 2), and the mouth, hand, knee, foot, and toe (each with n = 1). Fractures were most common to the hand (n = 2), followed by the back, lower arm, lower leg, foot, and toe (each with n = 1). The 5 sprain/strains were to the neck, wrist, finger, and ankle, with 1 to an unspecified location. The most common injury mechanisms were falling/being tripped (54.2%) and being hit (8.3%).


Figure 2
View larger version (21K):
[in this window]
[in a new window]

  		FIGURE 2 Description of camper injury. Only 1 response was allowed to each question. A, Primary body part injured. B, Injury mechanism. C, Injury diagnosis.

 
The majority of injuries were new (n = 43; 89.6%), as opposed to being recurrences or complications of an existing injury. Injured campers sustained additional injuries along with the primary injury reported in 36 (75.0%) injury events. The camper received training at camp before performing the activity during which the injury occurred in 16 (33.3%) injury events. Such training was not applicable in 28 (58.3%) cases. Protective equipment use was not applicable in 29 (60.4%) injury events and was being worn in 11 (23.0%) cases. However, in 4 (8.3%) injuries, the individual was not wearing the appropriate protective equipment. Injuries occurred most often on Wednesdays (n = 15; 32.6%) and Fridays (n = 9; 17.4%).

Of the 13 campers sustaining an injury resulting in their subsequent departure from camp, 3 were riding a horse, 3 were playing capture the flag, 2 tripped over objects while walking, 1 came into contact with poison ivy, 1 was injured at the end of a waterslide when another individual jumped on them, and 3 occurred during unspecified activities. The injuries sustained by these campers were cut/scratch/scrape (n = 4; 30.8%), sprain/strain (n = 3; 23.1%), fracture (n = 2; 15.4%), burn (n = 1; 7.7%), dislocation (n = 1; 7.7%), damage to an internal organ (n = 1; 7.7%), and an unspecified injury (n = 1; 7.7%).

Falling off a horse resulted in 7 (14.6%) injuries. These injuries resulted in 3 fractures, 2 bruises, 1 dislocation, and 1 damaged internal organ. The average age of these campers was 9.7 years (range: 7–13; SD = 2.1). All 7 of these campers required treatment at an offsite treatment facility, with 3 being admitted. Although 4 campers were able to return to normal activity within 1 day, 3 left after their injury.

Playing capture the flag was associated with 5 (10.2%) injuries, including 2 cut/scratch/scrapes, 2 sprain/strains, and 1 fracture. These injuries were all reported to occur either early in the morning (8 AM) or late in the evening (8–9 PM). The average age of these campers was 11.2 years (range: 8–17; SD = 3.5). Two of these individuals ran into or tripped over another camper, 1 stepped in a hole, 1 got sand in their eye, and 1 was injured through an "unknown" mechanism. Although 4 of these campers were treated at an offsite facility and released, 1 had to be admitted. One of these injured campers returned to normal activity within 1 day, 1 took >2 days to return to normal, and 3 left camp after the injury.


   DISCUSSION
TOP
 ABSTRACT
 METHODS
 RESULTS
 DISCUSSION
REFERENCES
 
Every summer millions of parents send their children to summer camps anticipating that the social and educational benefits of attending camp will outweigh the possibility of their child becoming sick or injured. This study, the first to describe camper illnesses and injuries in a sample of US summer camps, found an adverse event rate of 1.15 per 1000 camper-days. This is much lower than rates of injury reported among US youth participating in sports such as football (15 injuries per 1000 player-exposures),28 basketball (17 injuries per 1000 player-exposures),28 and soccer (21 injuries per 1000 player-exposures),28 especially given that a "player-exposure" typically constitutes only 1 game or practice, whereas a "camper-day" is composed of up to a 24-hour day. In addition, a nationally representative sample of US children involved in sports and recreational activities reported a rate of 59.3 injury episodes per 1000 persons.29 Although relatively small, surveillance studies such as this one can provide information to help reduce camp-related illnesses and injuries to their lowest possible rate by describing patterns of adverse events and identifying risk factors, information crucial to the development of general preventive interventions and risk management plans.

Our results build on previous studies of camper-related illness and injury that tended to be limited by short follow-up periods and small sample sizes. Reported illness and injury patterns in our study were similar to those found previously. A study of 3 US summer camps found that the most common complaints were injuries, communicable diseases, and allergies.23 Similarly, another study following US summer campers for only 2 weeks reported that injuries and infectious diseases were the most commonly reported incidents.25 A study at a resident US camp following campers for 4 weeks reported that injuries from sporting activities were the most common incidents, followed by upper respiratory ailments.26

Our adverse event rates are comparable to those reported previously. The few published studies providing camper incidence rates tended to use more restrictive inclusion criteria. For example, a camp study including only those injuries requiring a hospital referral reported a rate of 0.85 injuries per 1000 camper-days.24 Similarly, a canoe and backpacking camp study including only serious injuries reported an injury rate of 0.4 injuries per 1000 camper-days.27 Our adverse event rate seems to be the first accounting for both illness and injury among a representative sample of US summer camps.

The higher adverse event rate and the higher proportion of illnesses among resident camps compared with day camps found in this surveillance study may be because of differences in the amount of time campers spend at the facility because children spend less time at day camps compared with overnight camps. Unlike resident camps, where children are at camp continuously, parents are unlikely to send their child to a day camp if the child is not feeling well in the morning. Children contracting illnesses while at a day camp may not begin to show symptoms until they are back at home, precluding these children from presenting for treatment at camp. It is also possible that day camps may present fewer opportunities for injuries, either via a different set of camper activities or a different organizational structure that may lead to increased camper supervision.

The majority of camper injuries in this study occurred after noon in general and on Wednesdays and Fridays in particular. Camps should review their activity schedules in an attempt to determine the origin of these patterns. Future studies may want to examine any relationships between the day of the week and camp schedules or activities. Potential injury reduction interventions could include decreasing the amount of time campers spend in unsupervised activities during afternoons, providing staff the opportunity for longer lunch breaks to ensure that they are more alert during afternoons, and emphasizing safety messages throughout the week in an attempt to decrease the diminishing effect of the messages over time.

This surveillance study identified horseback riding and capture the flag as 2 activities with higher injury rates. Identifying such injury patterns provides an opportunity to implement prevention interventions. For example, in the single event causing the most injuries in this study, several campers from one camp riding horses near a road were injured when a passing truck spooked the horses. Although several of the campers were injured severely enough to require care at an offsite health care facility, their risk of severe injury was reduced because they were wearing helmets. Camps with equestrian activities should ensure that horses are assessed for spooking triggers (eg, loud noises and nearby traffic) and trail rides designed to minimize contact with these triggers. Similarly, the fast-paced game of capture the flag played over large camp areas was found to pose an injury risk via camper-to-camper contact, camper-to-fixed-object (eg, tree and post) contact, falls/trips, and so forth. Potential methods for increasing the safety of this game include ensuring that the game is only played in good lighting conditions (eg, not after dark or in the rain), is played on level ground if possible, and is played with adequate staff supervision. Future surveillance studies are needed to determine whether these 2 activities continue to produce a higher rate of injuries than other activities.

Camp epidemiological investigations identifying illness and injury patterns and risk factors can help camps develop safer facilities and procedures. For example, camps can decrease communicable illnesses through ongoing efforts to encourage good hygiene, including educating on proper hand-washing, providing adequate access to hand-washing facilities and/or hand sanitizers, and placing ill individuals in quarantine when warranted. Camps should also ensure that all of the campers and staff use appropriate protective equipment when participating in activities that call for such protection. When staff fail to use warranted protective equipment, they not only place themselves at increased risk of injury, but they also provide a poor example to campers who may be involved in or witness such unprotected activity.

This study has a few limitations. Not all of the camps completed an exposure report for each week of the study, nor was an illness or injury report form completed for each adverse event listed on the weekly exposure report. The study did not collect camp-specific descriptive data, such as terrain, health status of campers, and so forth, which may have been useful in designing prevention strategies specific to camp characteristics. Because of the limited numbers of illnesses and injuries collected by this pilot study, we did not have the statistical power to conduct age subgroup analyses. In addition, data for resident and day camps were pooled together, although the risk profiles of these 2 settings seem to be different. Despite these limitations, this study is the first to estimate rates of adverse events among campers in a sample of US summer camps. It included a larger number of camps, used a longer follow-up period, and was composed of more geographically diverse camps than research published previously. The study's success proves the ability to conduct long-term surveillance of illnesses and injuries in this setting.

Many of the illnesses and injuries sustained by children while attending summer camp may be prevented through the elimination or reduction of important risk factors for such events. This study highlights the need for the implementation and maintenance of a multiyear Internet-based illness and injury surveillance system to monitor camper adverse events and support the development and implementation of risk-reducing strategies. Such ongoing surveillance studies will allow researchers to calculate adverse event rates, monitor trends over time, and develop and evaluate evidence-based preventive interventions to provide a basis to help all camps provide the best possible place for children to gain skills to become healthy, productive adults.


   FOOTNOTES
 
Accepted May 24, 2006.

Address correspondence to Ellen E. Yard, MPH, Center for Injury Research and Policy, Columbus Children's Research Institute, Children's Hospital, 700 Children's Dr, Columbus, OH 43205. E-mail: yarde{at}ccri.net

The authors have indicated they have no financial relationships relevant to this article to disclose.


   REFERENCES
TOP
 ABSTRACT
 METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 

  1. Eels E. History of Organized Camping: The First 100 Years. Martinsville, IN: American Camp Association; 1986
  2. American Camp Association. Trend fact sheet. Available at: www.acacamps.org/media_center/camp_trends/fact.php. Accessed January 9, 2006
  3. American Camp Association. Directions: Youth Development Outcomes of the Camp Experience. Martinsville, IN: American Camp Association; 2005
  4. Coles FB, Kondracki SF, Gallo RJ, Chalker D, Morse DL. Shigellosis outbreaks at summer camps for the mentally retarded in New York State. Am J Epidemiol. 1989;130 :966 –975[Abstract/Free Full Text]
  5. Gross TP, Ratner L, de Rodriguez O, Farrell KP, Israel E. An outbreak of phototoxic dermatitis due to limes. Am J Epidemiol. 1987;125 :509 –514[Abstract/Free Full Text]
  6. Kirkland KB, Klimko TB, Meriwether RA, et al. Erythema migrans-like rash illness at a camp in North Carolina: a new tick-borne disease? Arch Intern Med. 1997;157 :2635 –2641[Abstract/Free Full Text]
  7. McLaughlin JB, Gessner BD, Lynn TV, Funk EA, Middaugh JP. Association of regulatory issues with an echovirus 18 meningitis outbreak at a children's summer camp in Alaska. Pediatr Infect Dis J. 2004;23 :875 –877[Web of Science][Medline]
  8. Roels TH, Wickus B, Bostrom HH, et al. A foodborne outbreak of Campylobacter jejuni (O:33) infection associated with tuna salad: A rare strain in an unusual vehicle. Epidemiol Infect. 1998;121 :281 –287[CrossRef][Medline]
  9. Rotz L, Callejas L, McKechnie D, et al. An epidemiologic and entomologic investigation of a cluster of Rocky Mountain spotted fever cases in Delaware. Del Med J. 1998;70 :285 –291[Medline]
  10. Schiff GM. Coxsackievirus B epidemic at a boys' camp. Am J Dis Child. 1979;133 :782 –785[Abstract/Free Full Text]
  11. Smith KE, Stenzel SA, Bender JB, et al. Outbreaks of enteric infections caused by multiple pathogens associated with calves at a farm day camp. Pediatr Infect Dis J. 2004;23 :1098 –1104[Web of Science][Medline]
  12. Kelly CS, Shield SW, Gowen MA, Jaganjac N, Andersen CL, Strope GL. Outcomes analysis of a summer asthma camp. J Asthma. 1998;35 :165 –171[Web of Science][Medline]
  13. Biggs KS, Heinrich JJ, Jekel JF, Cuono CB. The burn camp experience: variables that influence the enhancement of self-esteem. J Burn Care Rehabil. 1997;18 :92 –98[CrossRef]
  14. Martiniuk AL. Camping programs for children with cancer and their families. Support Care Cancer. 2003;11 :749 –757[CrossRef][Web of Science][Medline]
  15. Asnes RS, Feldman B, Gersony WM, Morrison S, Weiss M. The medical care of children at summer camps. An evaluation of 1,412 infirmary visits. Am J Dis Child. 1974;128 :64 –66[Abstract/Free Full Text]
  16. Barrett HS. Summer residential camp accidents, injuries and emergencies. Conn Med. 1969;33 :521 –523[Medline]
  17. Fiedelman W, Carbon K, Lewis D. Medical problems at a summer camp. N Y State J Med. 1983;83 :209 –212[Web of Science][Medline]
  18. Meyer RJ, Kibrick AK, Kibrick S, Ryan MP, Godbout R, Brown E. Epidemiology of summer camp accidents. Arch Environ Health. 1963;21 :325 –330
  19. Paffenbarger RS, Jr, Berg G, Clarke NA, Stevenson RE, Pooler BG, Hyde RT. Viruses and illnesses in a boys' summer camp. Am J Hyg. 1959;70 :254 –274[Web of Science][Medline]
  20. Rotman CB, Schmalz E. Illnesses and injuries in a summer camp. Am J Nurs. 1977;77 :821 –822[Web of Science][Medline]
  21. Stanilonis PB, Meyer RJ. Health and safety in summer camps. Public Health Rep. 1966;81 :305 –310[Web of Science][Medline]
  22. Saeger W, Schulz G, Frenzel A, Cropp S, Cropp E. Medical care in large camp grounds–a report of experiences [in German]. Offentl Gesundheitswes. 1989;51 :629 –634[Medline]
  23. Rauckhorst L, Aroian JF. Children's use of summer camp health facilities: a longitudinal study. J Pediatr Nurs. 1998;13 :200 –209[CrossRef][Medline]
  24. Wetterhall SF, Waxweiler RJ. Injury surveillance at the 1985 National Boy Scout Jamboree. Am J Sports Med. 1988;16 :534 –538[Abstract/Free Full Text]
  25. Key JD. Illness and injuries at summer camp. South Med J. 1997;90 :489 –492[Web of Science][Medline]
  26. Trachtman H, Woloski-Wruble AC, Kilimnick N, et al. Pediatric practice in a summer sleep-away camp. Clin Pediatr (Phila). 1994;33 :649 –653[Abstract/Free Full Text]
  27. Elliott TB, Elliott BA, Bixby MR. Risk factors associated with camp accidents. Wilderness Environ Med. 2003;14 :2 –8[Medline]
  28. Radelet MA, Lephart SM, Rubinstein EN, Myers JB. Survey of the injury rate for children in community sports. Pediatrics. 2002;110(3) . Available at: www.pediatrics.org/cgi/content/full/110/3/e28
  29. Conn JM, Annest JL, Gilchrist J. Sports and recreation related injury episodes in the US population, 1997–99. Inj Prev. 2003;9 :117 –123[Abstract/Free Full Text]
PEDIATRICS (ISSN 1098-4275). ©2006 by the American Academy of Pediatrics

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Facebook Facebook   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter    What's this?


This article has been cited by other articles:


Home page
 Inj. Prev.Home page
C L Collins, S K Fields, and R D Comstock
When the rules of the game are broken: what proportion of high school sports-related injuries are related to illegal activity?
Inj. Prev., February 1, 2008; 14(1): 34 - 38.
[Abstract] [Full Text] [PDF]

Home page
 Arch Pediatr Adolesc MedHome page
C. L. Collins, L. J. Micheli, E. E. Yard, and R. D. Comstock
Injuries Sustained by High School Rugby Players in the United States, 2005-2006
Arch Pediatr Adolesc Med, January 1, 2008; 162(1): 49 - 54.
[Abstract] [Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Yard, E. E.
Right arrow Articles by Comstock, R. D.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Yard, E. E.
Right arrow Articles by Comstock, R. D.
Related Collections
Right arrow Office Practice
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Facebook   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?