Global minimum estimates of children affected by COVID-19-associated orphanhood and deaths of caregivers: a modelling study.

BACKGROUND: The COVID-19 pandemic priorities have focused on prevention, detection, and response. Beyond morbidity and mortality, pandemics carry secondary impacts, such as children orphaned or bereft of their caregivers. Such children often face adverse consequences, including poverty, abuse, and institutionalisation. We provide estimates for the magnitude of this problem resulting from COVID-19 and describe the need for resource allocation. METHODS: We used mortality and fertility data to model minimum estimates and rates of COVID-19-associated deaths of primary or secondary caregivers for children younger than 18 years in 21 countries. We considered parents and custodial grandparents as primary caregivers, and co-residing grandparents or older kin (aged 60-84 years) as secondary caregivers. To avoid overcounting, we adjusted for possible clustering of deaths using an estimated secondary attack rate and age-specific infection-fatality ratios for SARS-CoV-2. We used these estimates to model global extrapolations for the number of children who have experienced COVID-19-associated deaths of primary and secondary caregivers. FINDINGS: Globally, from March 1, 2020, to April 30, 2021, we estimate 1 134 000 children (95% credible interval 884 000-1 185 000) experienced the death of primary caregivers, including at least one parent or custodial grandparent. 1 562 000 children (1 299 000-1 683 000) experienced the death of at least one primary or secondary caregiver. Countries in our study set with primary caregiver death rates of at least one per 1000 children included Peru (10·2 per 1000 children), South Africa (5·1), Mexico (3·5), Brazil (2·4), Colombia (2·3), Iran (1·7), the USA (1·5), Argentina (1·1), and Russia (1·0). Numbers of children orphaned exceeded numbers of deaths among those aged 15-50 years. Between two and five times more children had deceased fathers than deceased mothers. INTERPRETATION: Orphanhood and caregiver deaths are a hidden pandemic resulting from COVID-19-associated deaths. Accelerating equitable vaccine delivery is key to prevention. Psychosocial and economic support can help families to nurture children bereft of caregivers and help to ensure that institutionalisation is avoided. These data show the need for an additional pillar of our response: prevent, detect, respond, and care for children. FUNDING: UK Research and Innovation (Global Challenges Research Fund, Engineering and Physical Sciences Research Council, Medical Research Council), UK National Institute for Health Research, US National Institutes of Health, and Imperial College London.

Adverse Childhood Experiences During the COVID-19 Pandemic and Associations with Poor Mental Health and Suicidal Behaviors Among High School Students - Adolescent Behaviors and Experiences Survey, United States, January-June 2021.

Social and educational disruptions during the COVID-19 pandemic have exacerbated concerns about adolescents' mental health and suicidal behavior. Data from the 2021 Adolescent Behaviors and Experiences Survey (ABES) indicate that 37.1% of U.S. high school students reported poor mental health during the COVID-19 pandemic, with 19.9% considering and 9.0% attempting suicide in the preceding year (1). Adverse childhood experiences (ACEs)* are associated with poor mental health and suicidal behaviors (2,3), and high prevalence of some ACEs have been documented during the pandemic (4). ACEs are preventable, potentially traumatic events that occur in childhood (ages 0-17 years) such as neglect, experiencing or witnessing violence, or having a family member attempt or die by suicide. Also included are aspects of a child's environment that can undermine their sense of safety, stability, and bonding. Associations between ACEs occurring during the pandemic and mental health or suicidal behaviors among U.S. high school students were examined using ABES data. Experience of one to two ACEs was associated with poorer mental health and increased suicidal behaviors, and these deleterious outcomes increased with additional ACE exposure. After adjusting for demographic characteristics, adolescents who reported four or more ACEs during the pandemic had a prevalence of poor current mental health four times as high as, and a prevalence of past-year suicide attempts 25 times as high as, those without ACEs during the pandemic. Experience of specific ACE types (e.g., emotional abuse) was associated with higher prevalences of poor mental health and suicidal behaviors. Prevention and intervention strategies (5), including early identification and trauma-informed mental health service and support provision, for ACEs and their acute and long-term impacts could help address the U.S. child and adolescent mental health and suicide crisis.†.

Association between violence and mental distress, self-harm and suicidal ideation and attempts among young people in Malawi.

BACKGROUND: Mental health problems ranging from depression to more severe acts such as self-harm or suicidal behaviours are a serious problem among adolescents and young adults. Exposure to violence during the life of young people can increase mental health issues for youth. This study examines the relationship between exposure to violence and mental health issues among youth using a nationally representative study in Malawi. METHODS: We analysed data from the nationally representative Violence Against Children Survey from Malawi (2013) to quantify the association between exposures to violence (physical, sexual and emotional) and their relationship with mental distress, self-harm behaviours and suicidal ideation and attempts among youth aged 13-24 years. We evaluated the association of exposures to violence against children with reported mental health conditions among women and men. We used ordinal logistic regression models with appropriate survey weights to assess exposures to violence and the three outcomes of interest. RESULTS: Children and youth aged 13-24 years exposed to violence in childhood reported higher levels of adverse mental health effects, including mental distress, self-harm behaviours and suicidal ideation and attempts. The odds of reporting these outcomes increased as the number of violence types increased. CONCLUSIONS: Understanding the risks based on different combinations of exposures to violence in Malawi can help identify populations at higher risk and optimise violence prevention strategies.

Experiences of participation in a population-based survey on violence: Emotional discomfort, disclosure concerns, and the perceived value of participation among adolescents and young adults.

The accurate measurement of violence depends on high-quality data collected using methods that ensure participant confidentiality, privacy, and safety. To assess survey participants' emotional distress, discomfort, and self-perceived value of participating in the Honduras (2017), El Salvador (2017), Cote d'Ivoire (2018), and Lesotho (2018) Violence Against Children and Youth Surveys, which include sensitive topics such as sexual, physical, and emotional violence, we investigated individual self-reported distress and perceived value of participation by age, sex, and other demographic factors. We also examined the associations between past experiences of violence and both self-reported distress and perceived value of survey participation. Few individuals reported distress or concerns about disclosure. Across countries, 82.9% (Cote d'Ivoire) to 96.1% (Honduras) of participants indicated they were not afraid that someone might overhear their answers, 82.5% (Cote d'Ivoire) to 98.0% (El Salvador) said participation was not upsetting or stressful, and 93.3% (Cote d'Ivoire) to 98.6% (Honduras) said participation was worthwhile. The value of these interviews may exceed the negative feelings that some questions potentially elicit and can contribute to improved responses to victims.

Sampling design and methodology of the Violence Against Children and Youth Surveys.

INTRODUCTION: Globally 1 billion children are exposed to violence every year. The Violence Against Children Surveys (VACS) are nationally representative surveys of males and females ages 13-24 that are intended to measure the burden of sexual, physical and emotional violence experienced in childhood, adolescence and young adulthood. It is important to document the methodological approach and design of the VACS to better understand the national estimates that are produced in each country, which are used to drive violence prevention efforts. METHODS: This study describes the surveys' target population, sampling design, statistical considerations, data collection process, priority violence indicators and data dissemination. RESULTS: Twenty-four national household surveys have been completed or are being planned in countries across Africa, Asia, the Caribbean, Central and South America, and Eastern Europe. The sample sizes range from 891 to 7912 among females (72%-98% response rate) and 803-2717 among males (66%-98% response rate). Two face-to-face interviews are conducted: a Household and an Individual Questionnaire. A standard set of core priority indicators are generated for each country that range from prevalence of different types of violence, contexts, risk and protective factors, and health consequences. Results are disseminated through various platforms to expand the reach and impact of the survey results. CONCLUSION: Data obtained through VACS can inform development and implementation of effective prevention strategies and improve health service provision for all who experience violence. VACS serves as a standardised tool to inform and drive prevention through high-quality, comprehensive data.

What Do We Know About the Association Between Firearm Legislation and Firearm-Related Injuries?

Firearms account for a substantial proportion of external causes of death, injury, and disability across the world. Legislation to regulate firearms has often been passed with the intent of reducing problems related to their use. However, lack of clarity around which interventions are effective remains a major challenge for policy development. Aiming to meet this challenge, we systematically reviewed studies exploring the associations between firearm-related laws and firearm homicides, suicides, and unintentional injuries/deaths. We restricted our search to studies published from 1950 to 2014. Evidence from 130 studies in 10 countries suggests that in certain nations the simultaneous implementation of laws targeting multiple firearms restrictions is associated with reductions in firearm deaths. Laws restricting the purchase of (e.g., background checks) and access to (e.g., safer storage) firearms are also associated with lower rates of intimate partner homicides and firearm unintentional deaths in children, respectively. Limitations of studies include challenges inherent to their ecological design, their execution, and the lack of robustness of findings to model specifications. High quality research on the association between the implementation or repeal of firearm legislation (rather than the evaluation of existing laws) and firearm injuries would lead to a better understanding of what interventions are likely to work given local contexts. This information is key to move this field forward and for the development of effective policies that may counteract the burden that firearm injuries pose on populations.

Methodological proposal for implementing an intervention to prevent pedestrian injuries, a multidisciplinary approach: the case of Cuernavaca, Morelos, Mexico.

OBJECTIVE: To describe the process for implementing an intervention to prevent pedestrian injuries in Cuernavaca, Mexico, using a multidisciplinary and evidence-based approach. METHODOLOGY: This study included two phases with several stages. The first was an overall assessment of pedestrian mortality in Cuernavaca that included a comparison of pedestrian mortality between Cuernavaca and the rest of Morelos State (1998-2007), an analysis and geocoding of pedestrian injuries (2008-2009), and a description of techniques for selecting and analysing clustered events using road audits. The second phase focused on selecting an intervention through a review of the literature seeking the 'best evidence' adaptable to the local context and a methodological evaluation for implementation including techniques for cluster randomisation and for the evaluation of possible effects of the intervention. RESULTS: Between 2008 and 2009, in Cuernavaca there were 620 pedestrian injury events: 59.4% were men, the mean age was 36.3 years, 70% occurred during daylight hours, 55% had mild severity and there were no differences by sex (p>0.05). We generated evidence, that when combined with the results from a systematic search of the literature, provided sufficient information for the implementation of a pedestrian injury prevention intervention. CONCLUSIONS: A combination of strategies and disciplines makes it possible to comprehensively address this public health problem, allowing interventions to strengthen aspects of pedestrian safety while accounting for characteristics of the local context; the promotion of local measures, of low cost and high impact, with modifications to the road infrastructure, are more effective in addressing pedestrian vulnerabilities.

Excess Child Mortality Associated With Colombia's Armed Conflict, 1998-2019.

Importance: Armed conflicts are directly and indirectly associated with morbidity and mortality due to destruction of health infrastructure and diversion of resources, forced displacement, environmental damage, and erosion of social and economic security. Colombia's conflict began in the 1940s and has been uniquely long-lasting and geographically dynamic. Objective: To estimate the proportion of infant and child mortality associated with armed conflict exposure from 1998 to 2019 in Colombia. Design, Setting, and Participants: This ecological cohort study includes data from all 1122 municipalities in Colombia from 1998 to 2019. Statistical analysis was conducted from February 2022 to June 2023. Exposure: Armed conflict exposure was measured dichotomously by the occurrence of conflict-related events in each municipality-year, enumerated and reported by the Colombian National Center for Historic Memory. Main Outcomes and Measures: Deaths among children younger than 5 years and deaths among infants younger than 1 year, offset by the number of births in that municipality-year, enumerated by Colombia's national vital statistics. Results: The analytical sample included 24 157 municipality-years and 223 101 conflict events covering the period from 1998 to 2019. Overall, the presence of armed conflict in a municipality was associated with a 52% increased risk of death for children younger than 5 years of age (relative risk, 1.52 [95% CI, 1.34-1.72]), with similar results for 1- and 5-year lagged analyses. Armed conflict was associated with a 61% increased risk in infant (aged <1 year) death (relative risk, 1.61 [95% CI, 1.43-1.82]). On the absolute scale, this translates to a risk difference of 3.7 excess child deaths per 1000 births (95% CI, 2.7-4.7 per 1000 births) and 3.0 excess infant deaths per 1000 births (95% CI, 2.3-3.6 per 1000 births) per year, beyond what would be expected in the absence of armed conflict. Across the 22-year study period, the population attributable risk was 31.7% (95% CI, 23.5%-39.1%) for child deaths and 35.3% (95% CI, 27.8%-42.0%) for infant deaths. Conclusions and Relevance: This ecological cohort study of Colombia's spatiotemporally dynamic armed conflict suggests that municipal exposure to armed conflict was associated with excess child and infant deaths. With a record number of children living near active conflict zones in 2020, policy makers and health professionals should understand the magnitude of and manner in which armed conflicts directly and indirectly undermine child health.

The association between youth violence and mental health outcomes in Colombia: A cross sectional analysis.

BACKGROUND: Violence against children and youth poses public health risks regarding mental health symptoms and substance use. Less studied is the relationship between violence and mental health/substance abuse in the Latin American context. This study explored sex-stratified relationships between violence and mental health/substance use among Colombian youth. METHODS: We analyzed the 2018 Colombian Violence Against Children and Youth Survey, which collected cross-sectional data from Colombian youth (13-24 years) (n = 2705). Exposure variables were (i) binary sexual, emotional, and physical victimization and (ii) poly-victimization. The outcomes were binary suicidal thoughts, self-harm, past-month psychological distress, binge drinking, smoking, and drug use. Sex-stratified, logistic regressions were adjusted for age, primary school, parental presence, relationship status, and witnessing community violence. RESULTS: For females, (i) emotional violence (compared to being unexposed) was associated with greater odds of suicidal thoughts, self-harm, and psychological distress and (ii) sexual violence was associated with suicidal thoughts and self-harm. For males, (i) emotional violence (compared to being unexposed) was associated with greater odds of suicidal thoughts and psychological distress, but not self-harm and (ii) sexual violence exposure was associated with suicidal thoughts and self-harm. Physical violence was generally not associated with internalized mental health outcomes for females/males, when emotional and sexual violence were held constant. Poly-victimization was consistently and positively associated with internalized mental health symptoms among females, and to a lesser degree for males. Substance use outcomes for males or females were not associated with violence. CONCLUSIONS: Findings highlight the internalized mental health burden of emotional and sexual violence.

Path Analysis of Adverse Childhood Experiences, Early Marriage, Early Pregnancy, and Exposure to Intimate Partner Violence Among Young Women in Honduras.

Purpose: The pathways by which adverse childhood experiences (ACEs) are associated with early marriage and early pregnancy are poorly understood. Early marriage and early pregnancy may be risk factors for adulthood intimate partner violence (IPV). The aim of this study was to assess the relationships among ACEs, early marriage, early pregnancy, and IPV among women in Honduras. Method: We used weighted data from 1,436 women aged 18-24 years from the nationally representative 2017 Honduras Violence Against Children and Youth Survey. We used path analysis to estimate relationships and accounted for sample design, non-response, and within-country clustering. Results: We found that ACEs had differential relationships with outcomes of interest. For example, witnessing violence in the community was directly associated with increased probability of early pregnancy (10 percentage points (PP); 95% CI: 0.04, 0.15) and IPV (6 PP; 95% CI: 0.01, 0.10), while emotional violence was not directly or indirectly associated with any outcome. Early marriage and early pregnancy had no direct or indirect effect on IPV, but the total effect of early marriage on IPV was significant. Conclusions: Understanding the relationship between ACEs, early marriage, early pregnancy, and IPV may help inform prevention efforts. For example, programs aiming to reduce early pregnancy may consider addressing sexual violence experienced in childhood.

Adolescents' Adverse Childhood Experiences, Poor Mental Health, and Substance Use During the COVID-19 Pandemic.

PURPOSE: Adverse childhood experiences (ACEs) increase the risk for poor mental health (MH) and substance use. We describe relationships between adolescents' ACEs, substance use, and poor MH occurring during the COVID-19 pandemic. METHODS: We conducted a secondary analysis of data among U.S. high school students aged <18 years, who participated in the nationally representative Adolescent Behaviors and Experiences Survey. Data were collected from January to June 2021. Bivariate and multivariable analyses assessed associations between individual ACEs (physical, emotional abuse by parent or caregiver, parent or caregiver job loss, food insecurity, sexual violence, physical dating violence, or cyber bullying) and cumulative ACEs (0, 1-2, 3, 4+) experienced during the pandemic and substance use; stratified analyses assessed effects of poor MH on associations between ACEs and substance use. RESULTS: Use of all substances was higher among adolescents with ACEs, particularly those who experienced both ACEs and poor MH during the COVID-19 pandemic. Prevalence of substance use was especially high among adolescents exposed to any sexual violence or physical dating violence. Compared to adolescents without ACEs, a higher percentage of adolescents with 4+ ACEs reported current use of alcohol (adjusted prevalence ratio [aPR], 5.32) or marijuana (aPR, 5.86), misuse of prescription pain medications (aPR, 8.82), binge drinking (aPR, 7.70), and increased alcohol (aPR, 6.54) or drug (aPR, 7.09) use during the pandemic. DISCUSSION: The individual and combined impact of ACEs and MH on adolescent substance use reinforce the need for trauma-informed care and primary prevention of ACEs to prevent and mitigate poor MH and substance use among adolescents.

The effectiveness of Hope Groups, a mental health, parenting support, and violence prevention program for families affected by the war in Ukraine: Findings from a pre-post study.

Background: Nearly one in six children lived in war zones in 2023. Evidence-based psychosocial and parenting support has potential to mitigate negative impacts for parents and children co-exposed to war and displacement, especially in relation to mental health and harsh parenting reactions. In the current war in Ukraine, local mental health experts co-created and evaluated, with global experts, the effectiveness of psychosocial and parenting support groups, called 'Hope Groups' on improvements in mental health, positive parenting, and violence against children. This paper aimed to assess the effectiveness of psychosocial and parenting support groups, called 'Hope Groups,' on improvements in caregiver mental health, positive parenting, and prevention of violence against children, for families affected by the war in Ukraine, using a pre/post study design. Methods: Participants (n = 577) included Ukrainian caregivers, 66% (381) of whom were parents and co-residing caregivers of children ages 0-17, while the remaining 34% were non-resident informal caregivers. Internally displaced, externally displaced, and those living at-home in war-torn regions were invited to groups by trained Ukrainian peer facilitators. Using a pre-post design, we compared individual level frequency measures at three time-points - baseline, midline, and endline, to assess changes in 4 mental health, and 9 parenting and child health outcomes. We analyzed these outcomes using paired t-tests to compare outcomes at baseline-to-midline (after 4-sessions) and baseline-to-endline (after 10-sessions), which estimated the mean changes in days per week and associated percent change, during the respective periods; we quantified uncertainties using bias-corrected and accelerated (BCa) bootstrapping with 95% uncertainty ranges for baseline-midline and baseline-endline estimates. We used this same approach for stratified analyses to assess potential effect modification by displacement status and facilitator type. We further used linear models to adjust for age and sex. Findings: Compared to baseline, every mental health, parenting, and child health outcome improved significantly at midline and endline. Mental health ratings showed endline reductions in depressive symptoms of 56.8% (95% CI: -59.0,-54.3; -1.8 days/week), and increases in hopefulness, coping with grief, and self-care, ranging from 62.0% (95% CI: 53.6,71.3; 2.2 days/week) to 77.0% (95% CI: 66.3,88.3; 2.2 days/week). Significant improvements in parenting and child health outcomes included monitoring children, reinforcing positive behavior, supporting child development, protecting child, nonviolent discipline, and child verbalizing emotions. By endline, emotional violence, physical violence, and child despondency had dropped by 57.7% (95% CI: -63.0%,-51.9; -1.3 days/week), 64.0% (95% CI: -79.0,-39.5; -0.22 days/week), and 51.9% (95% CI: -45.1,-57.9; -1.2 days/week), respectively. Outcomes stratified by displacement status remained significant across all groups, as did those according to facilitator type (lay versus professional). Interpretation: This study demonstrates preliminary evidence, using a brief survey and pre-post design as is appropriate for acute and early protracted emergency settings, of the feasibility and effectiveness of Hope Groups for war-affected Ukrainian caregivers, on improved mental health, positive parenting, and reduced violence against children.

Associations between conflict violence, community violence, and household violence exposures among females in Colombia.

BACKGROUND: Exposure to protracted public violence is increasingly referenced as a risk factor for domestic violence, but limited quantitative evidence has demonstrated this association to date. This study analyzes associations in Colombia between lifetime experiences of external violence, including the Colombia civil conflict and community interpersonal violence, and experiences of household violence, including intimate partner and caregiver violence. METHODS AND FINDINGS: We use the 2018 Colombia Violence Against Children and Youth Survey, employing multi-variable logistic regressions to determine the association between exposure to external violence and household violence victimization for females aged 13-24 (n = 1406). Adjusted models controlled for age, ever married, currently in school, and past 12-mo work experience and standard errors were adjusted to account for the multi-stage sampling design. Females who had ever witnessed community violence (39.23 %) faced increased risks of experiencing both physical violence (aOR = 2.81; 95 % CIs: 1.54-5.14; p < 0.001) and emotional violence (aOR: 2.48; 95 % CIs: 1.29-4.75; p < 0.01) from caregivers. Females who had ever witnessed internal conflict (15.99 %) had a greater likelihood of experiencing emotional violence from caregivers (aOR: 5.24; 95 % CIs: 1.86-14.76; p < 0.01) as well as physical violence perpetrated by intimate partners (aOR: 3.31; 95 % CIs: 1.22-8.95; p < 0.05). CONCLUSIONS: This study demonstrates the connection between exposure to community violence and internal conflict and household violence victimization among adolescent and young adult females in Colombia. Findings build the evidence base for more holistic and coordinated policy and programming efforts and foreground the need to identify and support vulnerable populations across socioecological domains in contexts of chronic violence.

COVID-19 Pandemic Impact on United States Intimate Partner Violence Organizations: Administrator Perspectives.

Purpose: The COVID-19 pandemic has increased challenges to intimate partner violence (IPV) service provision. This study aimed to explore administrative perspectives on the impacts of the COVID-19 pandemic on United States regional and national IPV service organizations. Methods: We interviewed 35 administrators working within state, regional, or national organizations addressing IPV. Interview domains included (1) organizational response to COVID-19, including communication and supporting employees and partner agencies, (2) impact on marginalized communities, and (3) resource needs. We used a hybrid deductive-inductive approach and thematic analysis for coding and analysis. Results: We identified four key themes: (1) COVID-19 worsened pre-existing challenges and created new challenges at multiple levels within IPV service organizations; (2) IPV service organizations initiated multi-level initiatives to support IPV survivors, their staff, their organization, and their member/partner agencies; (3) Organizations identified changes that should continue beyond the pandemic; and (4) Systemic racism compounded the impact of COVID-19 on IPV survivors and IPV service agencies. Conclusions: Findings suggest that (1) multi-level responses are needed for robust support of IPV survivors during and beyond the pandemic and (2) a syndemic model that addresses underlying structural inequities may strengthen efforts to support IPV survivors during a pandemic or other large-scale disaster.

Biomarkers of incident radiographic knee osteoarthritis: do they vary by chronic knee symptoms?

OBJECTIVE: To explore the ability of osteoarthritis (OA)-related biomarkers to predict incident radiographic knee OA in a large sample of African American and Caucasian men and women. METHODS: Baseline levels of serum cartilage oligomeric matrix protein (COMP), hyaluronan (HA), high-sensitivity C-reactive protein (hsCRP), and keratan sulfate (KS) and baseline and followup radiographs were available for 353 knees without baseline osteophyte formation and for 446 knees without baseline joint space narrowing (JSN). Cox models estimated the hazard ratio (HR) and 95% confidence interval (95% CI) for incident knee OA for a 1-unit increase in the ln of each biomarker, with adjustment for age, race, sex, body mass index, and knee OA of the contralateral limb. Report of chronic knee symptoms was explored as a modifier of the association. RESULTS: The hazard of incident knee osteophytes (HR 2.16 [95% CI 1.39-3.37]) and incident JSN (HR 1.82 [95% CI 1.15-2.89]) increased with higher baseline ln(COMP) levels. The hazard of incident knee JSN increased with higher ln(HA) levels (HR 1.46 [95% CI 1.14-1.87]). Baseline ln(hsCRP) and ln(KS) did not predict incident knee outcomes. HRs per unit increase in ln(COMP), ln(HA), and ln(KS) were higher among knees with chronic symptoms than among those without symptoms. CONCLUSION: Higher baseline ln(COMP) and ln(HA) levels were associated with incident knee OA over an average followup period of 6.3 years. These results represent detection of a molecular stage of OA prior to radiographic manifestations. Further exploration is needed to determine how chronic knee symptoms modify the biomarker-incident knee OA association.

Incidence of severe work-related injuries among young adult workers in Brazil: analysis of compensation data.

OBJECTIVES: To obtain national estimates of the annual cumulative incidence and incidence density of severe non-fatal injuries using compensation benefits data from the Brazilian National Social Security Institute (INSS), and to describe their sociodemographic distribution among workers aged under 25 years. METHODS: Data are records of health-related compensation benefits from the Ministry of Social Insurance's information system of compensation benefits of the INSS recorded in 2006. Injuries were cases classified under chapter XIX, ICD-10. The assessment of their relation with work was made by INSS's occupational physician experts. The study population comprised young workers aged 16-24 years. RESULTS: 59,381 workers received compensation benefits for injuries in the study year. Among them 14,491 (24.4%) were work related, 12,501 (86.3%) were male and 1990 were female workers (13.7%). The annual cumulative incidence rate of work-related injuries (ACI-WI) was 2.9×1000 workers, higher among men (4.2×1000) than women (1.0×1000). The incidence density rate (IDR-WI) was 0.7/1000 full-time equivalent (FTE), higher for men (0.97/1000 FTE) than women (0.24/1000 FTE). Both morbidity measures were higher in the younger group (16-19 years), and inversely related to wage, especially for women in the younger group. Logging, extraction, food/beverage and construction industries had higher ACI-WI and IDR-WI for adolescents and young adult workers of both sex groups. CONCLUSIONS: These findings suggest that the Brazilian labour laws limiting young adult workers in hazardous settings need to be expanded, adding occupations in other extractive industries and certain types of work in the food/beverage manufacturing industries. Social inequalities associated with sex need to be examined further with more detailed data.

Pedestrians' perceptions of walkability and safety in relation to the built environment in Cali, Colombia, 2009-10.

OBJECTIVE: To assess pedestrians' perceptions of the walkability of the urban environment and pedestrian safety in Cali, Colombia. DESIGN: Standardised intercept interviews were conducted of 400 pedestrians walking in 20 randomly selected urban zones to ascertain frequency of walking, and perceptions of safety, the built environment and security. Four focus group meetings were held with community members and students addressing these issues in an open-ended forum. The study analysed quantitative data collected in street interviews and qualitative information from focus groups addressing respondents' views on problems for pedestrians, how the built environment affects walking and ideal walking conditions. RESULTS: Access to public transportation was deemed the most positive characteristic of the built environment and 61% of respondents liked walking in the street. When disaggregating street conditions, the majority of pedestrians were dissatisfied with their walking experiences. Pedestrians cited lack of respect for norms, personal safety and built environment characteristics as their main concerns. Among frequent walkers, residents tended to rate their neighbourhoods more negatively compared with non-residents. Through qualitative interviews it became apparent that narrow sidewalks that are frequently obstructed by motor vehicles are a key reason for pedestrian dissatisfaction. A perception of overall insecurity further determines how pedestrians assess or modulate their walking in this city. CONCLUSIONS: Overall, walking in Cali was perceived negatively by pedestrians because of built environment characteristics and perceptions of insecurity. Qualitative information used to complement intercept surveys can provide a better way to identify pedestrian-specific transport-related problems.

Workdays lost due to occupational injuries among young workers in Brazil.

BACKGROUND: The severity of non-fatal work-related injuries has seldom been examined among young workers. We estimated the extent and distribution of workdays lost due to non-fatal work injuries using compensation data. METHODS: Data are from the Brazilian Institute of Social Insurance, for 2006. The study population is comprised of all insured workers of age 16-24. Descriptive statistics reflect workdays lost due to health-related disability, according to sex, age group, wage, and trade. RESULTS: Out of 4.8 million insured workers ages 16-24 years, we estimated 1,282,940 workdays lost. We observed a larger number of median workdays lost among males age 20-24 in retail and service trades (83 days) and among 16-19-year-old females in the agriculture/fish/forestry/cattle (142 days). CONCLUSIONS: Young workers experience a heavy burden of work-related injuries. Disability workdays may compromise school attendance and performance. Other potential impacts affect productivity and social insurance costs.

Predicting adolescent boys' and young men's perpetration of youth violence in Colombia.

Youth violence poses a substantive public health burden in Latin America, particularly among adolescent boys and young men. Understanding predictors of youth violence perpetration among boys and young men is critical to more effectively target and tailor prevention programs, especially in Colombia, which has endured decades-long internal armed conflict. This study uses Colombia's nationally representative 2018 Violence Against Children and Youth Survey data to examine risk and protective factors associated with violence perpetration among 13- to 24-year-old male. Amongst adolescent boys and young men in Colombia, the prevalence of ever perpetrating violence against someone other than an intimate partner was approximately 23%. Multivariable logistic regression models revealed that physical violence victimization by peers, emotional violence victimization by caregivers, having lost or been separated from a mother during childhood, and witnessing community violence were all associated with lifetime perpetration of youth violence. Programs targeting reduction of youth violence among boys might consider addressing the previously identified predictors earlier in the life course and at the individual, family and community levels.

Violence Exposure Among Adolescent Boys and Young Men in Colombia With a Lifetime History of Transactional Sex.

PURPOSE: There is a paucity of research examining the contextual factors that shape the violence experienced by those engaged in transactional sex, particularly among adolescent boys and young men. Recognizing the acute vulnerability among youth engaged in transactional sex, this analysis examined the associations between lifetime transactional sex and experience of violence among 13- to 24-year-old males. METHODS: Using data from two strata of the 2018 Violence Against Children and Youth Survey from Colombia, logistic regressions were used to estimate the association between engagement in transactional sex and violence exposure. Three groups of violence outcomes were examined: violence victimization, violence perpetration, and witnessing violence. RESULTS: Violence victimization and witnessing violence were widespread. Adolescent boys and young men with a lifetime history of transactional sex were significantly more likely to experience violence victimization than those without a lifetime history of transactional sex, particularly intimate partner violence (adjusted odds ratio [aOR]: 5.23 and 5.41) and caregiver emotional violence (aOR: 7.23 and 8.74). In the national and priority samples respectively, those with a lifetime history of transactional sex were also significantly more likely to witness violence within the home (aOR: 4.42 and 4.99) and outside of the home (aOR: 7.24 and 28.32). DISCUSSION: Although research is needed to determine causal pathways, our findings highlight the ubiquity of violence and the criticality of supporting this group of adolescent boys and young men. Interventions for those with a history of transactional sex should address factors that may contribute to drivers of violence and transactional sex.