PHYSICAL FIGHTING AND FIGHTING-RELATED INJURIES IN CANADIAN ADOLESCENTS: A DEMOGRAPHIC ANALYSIS AND ASSESSMENT OF THE EFFECTS OF FAMILY AFFLUENCE
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BACKGROUND: Physical fighting is a concerning behaviour among adolescents and can lead to injury. Family affluence can influence adolescent injury, but its impact on injury has not been extensively explored in a fighting context. OBJECTIVES:1) To describe the prevalence and trends of physical fighting and fighting-related injury in Canadian adolescents over time, 2) to examine the association between family affluence and the outcomes of physical fighting and fighting-related injury. METHODS: Manuscript 1. Canadian data from cycles 2-6 of the Health Behaviour in School-aged Children (HBSC) Study were used (N=61,465 grade 6-10 students). Cross-tabulations were used to calculate proportions and risk estimates by sex, grade, and self-perceived affluence. A trend analysis was conducted across time cycles. Manuscript 2. HBSC data from 2009/2010 were used (N=26,078). Poisson regression was performed to compare the risk of physical fighting and fighting-related injury at different affluence levels. Three affluence indicators were used: self-perceived affluence, family affluence scale (FAS), and area-level average household income. RESULTS: Manuscript 1. A significant change was observed over time for physical fighting (Ptrend=0.015) and fighting-related injury overall (Ptrend<0.001). Although for fighting especially, more time-points are necessary to confidently determine the extent and direction of trend. Males were twice as likely to report both outcomes compared to females (p=0.001-0.044). There was a decreased risk of fight involvement from lower to higher grades (ptrend<0.001), but an increased risk for fighting-related injury with increasing grades (ptrend=0.001-0.261). Decreased affluence was associated with a higher risk of both outcomes (ptrend=0.001-0.913). Manuscript 2. Patterns were generally similar in all three measurements, although the gradient strength varied for each measure. Self-perceived affluence showed a stronger inverse gradient in girls than boys. FAS showed a similar inverse gradient within females, and low FAS greatly influenced both outcomes in males. Area-level income only presented a significantly higher likelihood for fighting in females (low RR=1.26, 95% CI: 1.08-1.46), and insignificant associations with fighting-related injury. CONCLUSION: Physical fighting and fighting-related injury have changed over time. Specific subgroups, especially those of lower affluence, are at higher risk for both outcomes. The strength of the association varied depending on which affluence measurement was used.