The Association Between Head and Neck Injuries Requiring Medical Attention and Behavioural Problems Among 7- and 14-Year-Old Adolescents Living in the United Kingdom A Secondary Data Analysis of the UK Millennium Cohort Study (MCS)

Abstract

Background: Injuries are major public health problems that affect children’s lives. Behavioural problems have been linked to increased risk of injury incidence. However, few studies discussed the association between externalising and internalising behavioural problems and head and neck injuries among children and adolescents. Aim: This study aims to examine the association between head and neck injuries requiring medical attention and behavioural problems among 7- and 14-year-old youth living in the UK. Methods: A secondary analysis of data from the Millennium Cohort Study (MCS) was conducted using the fourth and sixth sweeps when the participants were 7 and 14 years old. The outcome indicated whether the child had sustained any head and neck injuries since the last survey. Behavioural problems were assessed using the Strengths and Difficulties Questionnaire (SDQ) subscales of externalising and internalising behaviour. In the analysis both scales were dichotomised (10% highest scores) to discern those experiencing severe difficulties. Demographic, family, and socioeconomic factors were used as covariates. Weighted analysis using regression modelling was used to examine the associations between behavioural problems and head and neck injuries. Results: The prevalence of head and neck injuries for 7- and 14-year-olds were 9.35% and 6.23% respectively. Externalising behavioural problems at age 7 were reported for just under 10% of the children, and nearly 9% were reported to experience Internalising problems. At age 14, over 10% of the sample presented with externalising behavioural problems, and nearly 8% with Internalising behaviours. Children aged 7 years who presented with externalising difficulties had a significantly higher risk of head and neck injuries in the crude model (OR=1.41, 95%CI: 1.02–1.93). However, this association became non-significant after controlling for child characteristics. In the crude model, there was no difference in head and neck injury odds between children with internalising behavioural problems and their peers at age 7 (OR=1.00, 95%CI: 0.67–1.48). The association remained non-significant after subsequent adjustments. For 14-year-olds, those who with externalising problems appeared to have higher odds of head and neck injuries compared to their peers, although not statistically significant in the crude model (OR=1.25, 95%CI: 0.79–1.98) or after adjustments (final model: OR=1.27, 96%CI: 0.80 – 2.02). There was no difference between children aged 14 experiencing internalising difficulties and their peers in the crude model (OR=0.69, 95%CI: 0.35–1.36) or after adjustments (final model: OR=0.69, 96%CI: 0.36 – 1.32). Conclusion: This study indicated that children aged 7 with externalising behavioural problems were at higher risk for head and neck injuries. However, after adjusting for confounding factors, this association became non-significant. In early adolescence (age 14), such injuries were not significantly associated with externalising difficulties. Internalising problems showed no significant association with head and neck injuries in either age group.