An Epidemiological Study On The Relationship Between Behavior Problems And Injuries Of School-age Children

Objectives To investigate the epidemiological features of behavior problems and the annual incidence of injuries among school-age children, study the influential factors for different types of behavior problems and injuries, and explore the relationship between behavior problems and injuries among school-age children. Methods Firstly, a cross-sectional study was conducted with 3 887 pupils from grade 1 to grade 5 of three primary schools, which was selected by cluster sampling in Maanshan city. The Rutter Child Behavior Questionnaire (for completion by parent) and self-designed checklist of relevant factor were used to rate behavior and explore influential factors for behavior problems among them. Secondly, a 1:1 matched case-control study was carried out among children with behavior problems and controls rated by the Rutter Child Behavior Questionnaire. The influential factors for antisocial behavior, neurotic behavior and mixed behavior were analyzed by conditional logistic regression model. Lastly, a prospective cohort study on injuries for 1-year follow-up period was conducted with 2 005 school-age children selected by cluster sampling in the three primary schools. They were divided into two cohorts with or without exposure according to behavior problems rated at the beginning of the study. Nonparametric test (Wilcoxon rand sum test) was performed to analyze the differences in injuries between the two cohorts of children, and the influential factors for injuries were analyzed with multi-classification ordinal response variable logistic regression model. Results The total detected rate of behavior problems in school-age children was 15.46%. The detected rate of antisocial behavior, neurotic behavior and mixed behavior was 6.60%, 5.86% and 3.00%, respectively. The result by multivariate conditional logistic regression model indicatedthat poor health status of parents, frequently taking punishment on child and maternal severe anemia during pregnancy were the possible risk factors for children antisocial behavior; maternal bad mood during pregnancy and vaginal bleeding in first trimester gestation were the possible risk factors for neurotic behavior; maternal bad mood during pregnancy was the possible risk factor for mixed behavior, and high level of fathers education was the possible preventive factor for mixed behavior. The overall incidence rate for injuries in school-age children was 42.51%, which among children with and without behavior problems was 64.87% and 38.85%, respectively. There were significant differences between the two cohorts (u=6.054, P<0.01) . But among school-age children with three types of behavior problems no significant differences in the incidence of injuries were found (P>0.05 ). Mutivariate analysis showed that injuries in school-age children were positively associated with childhood behavior problems, younger maternal age at childbirth, bad mood or diseases during pregnancy, high level of mothers education and unsound prevention measures for safety at home, adult's care when child going to school or returning home after school was negatively associated with injuries. While different types of behavior problems of children were the major risk factors for injuries. Conclusions Behavior problems of school-age children are influenced by multiple factors, such as maternal bad conditions in pregnancy or perinatal period, family environmental factors, self-factors of children and so on. It is essential to take comprehensive measures to protect children from behavior disorders. Children with behavior problems represent a significant risk group for injuries among school-age children. When planning intervention strategies on injuries, behavior problems should be emphasized to ensure optimal effectiveness of intervention.