{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,16]],"date-time":"2025-06-16T07:40:08Z","timestamp":1750059608918,"version":"3.41.0"},"reference-count":33,"publisher":"BMJ","issue":"3","funder":[{"name":"New Zealand Ministry of Social Development","award":["Children and Families Research Fund (reference: 50"],"award-info":[{"award-number":["Children and Families Research Fund (reference: 50"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Inj Prev"],"accepted":{"date-parts":[[2023,11,9]]},"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:sec><jats:title>Aim<\/jats:title><jats:p>Approaches to understanding child injury tend to focus on short-term proximal influences. Previous analyses have found higher rates of injury among M\u0101ori and Pacific children in Aotearoa New Zealand (NZ). This study aimed to investigate how combinations of situations and multiple events act across the life-course to either protect preschool children from, or place them at risk of, repeated injuries requiring medical attention.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Longitudinal data were used to identify parent-reported injuries requiring medical attention among 6114 preschool NZ children. The environments experienced by children with multiple and\/or severe injury were explored using multivariable analyses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Eight percent of children (n=505) experienced 1\u20133 injuries with at least one hospitalisation or \u22654 injuries (<jats:italic>high injury<\/jats:italic>group) from birth to 4.5 years of age. After accounting for antenatal, sociodemographic and psychosocial variables, children of M\u0101ori mothers (OR=0.7, 95% CI 0.5 to 0.97) and children of Asian mothers (OR=0.5, 95% CI 0.3 to 0.7) were less likely to be in the<jats:italic>high injury<\/jats:italic>group than children of European mothers. After adjusting for maternal ethnicity and child variables (gender, temperament, level of activity and behaviour difficulties), cumulative exposure to factors in four domains was associated with injury category: maternal, family, social and service use.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study identified social and economic opportunities to lower rates of injury among preschool children, that might reduce associated direct and indirect costs. Our findings in relation to ethnicity go against the standard public rhetoric and provide support for shifting the apportioning of blame for child injury from individuals to wider environmental exposures for which public health and societal solutions are required.<\/jats:p><\/jats:sec>","DOI":"10.1136\/ip-2023-044869","type":"journal-article","created":{"date-parts":[[2023,12,1]],"date-time":"2023-12-01T18:21:29Z","timestamp":1701454889000},"page":"233-238","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Manifold child, family and social variables are associated with injury among New Zealand preschool children"],"prefix":"10.1136","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7775-8272","authenticated-orcid":false,"given":"Lisa","family":"Underwood","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2537-4688","authenticated-orcid":false,"given":"Bridget","family":"Kool","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Avinesh","family":"Pillai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Te Kani","family":"Kingi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan","family":"Morton","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shanthi","family":"Ameratunga","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,12,1]]},"reference":[{"key":"2025061600001170000_30.3.233.1","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1111\/j.1440-1754.2011.02026.x","article-title":"Child and adolescent injury report card: New Zealand 2009","volume":"47","author":"Bland","year":"2011","journal-title":"J Paediatr Child Health"},{"key":"2025061600001170000_30.3.233.2","unstructured":"Injury Prevention Research Unit . Fact Sheet 43: Injury as a leading cause of death and hospitalisation. Dunedin: Injury Prevention Research Unit,"},{"key":"2025061600001170000_30.3.233.3","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1111\/1753-6405.12101","article-title":"Preventing child unintentional injury deaths: prioritizing the response to the New Zealand child and adolescent injury report card","volume":"37","author":"Shepherd","year":"2013","journal-title":"Aust N Z J Public Health"},{"key":"2025061600001170000_30.3.233.4","unstructured":"ACC . Information obtained under the official information act on unintentional child injuries for the period 1 July 2012 \u2013 30 June 2017; 2017."},{"key":"2025061600001170000_30.3.233.5","first-page":"25","article-title":"The societal cost of unintentional childhood injuries in Aotearoa","volume":"134","author":"Young","year":"2021","journal-title":"N Z Med J"},{"key":"2025061600001170000_30.3.233.6","unstructured":"NZ Injury Query System . 2013 to 2018 New Zealand public hospital injury discharges, all injury, unintentional intent, both genders, 0 to 19 year olds, all NZ: injury prevention research unit, Department of preventive and social medicine, University of Otago, New Zealand. 2020. Available: https:\/\/psm-dm.otago.ac.nz\/niqs\/ [Accessed 30 Apr 2020]."},{"key":"2025061600001170000_30.3.233.7","unstructured":"Safekids Aotearoa . Child Unintentional Deaths and Injuries in New Zealand, and Prevention Strategies. Auckland: Safekids Aotearoa, 2015."},{"key":"2025061600001170000_30.3.233.8","unstructured":"Simpson J , Duncanson M , Oben G , et al . Te Ohonga Ake The Health of M\u0101ori Children and Young People in New Zealand Series Two. Dunedin: New Zealand Child and Youth Epidemiology Service, University of Otago, 2017."},{"key":"2025061600001170000_30.3.233.9","unstructured":"Growing Up in New Zealand . Growing Up in New Zealand Policy Brief. Keeping our children injury-free: household safety evidence from Growing Up in New Zealand. Auckland: Growing Up in New Zealand, 2014."},{"key":"2025061600001170000_30.3.233.10","unstructured":"Robson B , Harris R , eds. Hauora: M\u00e0ori Standards of Health IV. A study of the years 2000\u20132005. Wellington: Te R\u00f2p\u00f9 Rangahau Hauora a Eru P\u00f2mare, 2007."},{"key":"2025061600001170000_30.3.233.11","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1111\/1753-6405.13125","article-title":"Risk factors of unintentional injury among children in New Zealand: a systematic review","volume":"45","author":"Ghebreab","year":"2021","journal-title":"Aust N Z J Public Health"},{"key":"2025061600001170000_30.3.233.12","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyg154"},{"key":"2025061600001170000_30.3.233.13","doi-asserted-by":"publisher","DOI":"10.1136\/jech.2007.068072"},{"key":"2025061600001170000_30.3.233.14","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1754.2006.00810.x"},{"key":"2025061600001170000_30.3.233.15","doi-asserted-by":"publisher","DOI":"10.1136\/ip-2023-044845"},{"key":"2025061600001170000_30.3.233.16","doi-asserted-by":"publisher","DOI":"10.1136\/ip.2.2.98"},{"key":"2025061600001170000_30.3.233.17","doi-asserted-by":"publisher","DOI":"10.1136\/ip.2009.022483"},{"key":"2025061600001170000_30.3.233.18","doi-asserted-by":"publisher","DOI":"10.1093\/jpepsy\/8.2.181"},{"key":"2025061600001170000_30.3.233.19","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2008.05.018"},{"key":"2025061600001170000_30.3.233.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2005.04.003"},{"key":"2025061600001170000_30.3.233.21","doi-asserted-by":"publisher","DOI":"10.1093\/her\/cyh021"},{"key":"2025061600001170000_30.3.233.22","doi-asserted-by":"publisher","DOI":"10.1136\/jech.2003.015255"},{"key":"2025061600001170000_30.3.233.23","doi-asserted-by":"publisher","DOI":"10.1177\/0163278712462717"},{"key":"2025061600001170000_30.3.233.24","doi-asserted-by":"publisher","DOI":"10.1111\/1753-6405.12220"},{"key":"2025061600001170000_30.3.233.25","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyr206"},{"key":"2025061600001170000_30.3.233.26","unstructured":"Morton SMB , Grant CC , Berry SD , et al . Growing Up in New Zealand: A longitudinal study of New Zealand children and their families. Now We Are Four: Describing the preschool years. Auckland: Growing Up in New Zealand, 2017."},{"key":"2025061600001170000_30.3.233.27","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.aje.a117592"},{"key":"2025061600001170000_30.3.233.28","unstructured":"Kool B , Underwood L , Morton S , et al . Child injury in the preschool years. Wellington: NZ Ministry of Social Development, 2021."},{"key":"2025061600001170000_30.3.233.29","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-7610.1997.tb01545.x"},{"key":"2025061600001170000_30.3.233.30","doi-asserted-by":"publisher","DOI":"10.1207\/s15327752jpa8701_09"},{"key":"2025061600001170000_30.3.233.31","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2458-11-695","article-title":"A life course approach to injury prevention: a 'lens and telescope' conceptual model","volume":"11","author":"Hosking","year":"2011","journal-title":"BMC Public Health"},{"key":"2025061600001170000_30.3.233.32","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)61006-0"},{"key":"2025061600001170000_30.3.233.33","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1111\/1753-6405.12695","article-title":"Housing tenure as a focus for reducing inequalities in the home safety environment: evidence from growing up in New Zealand","volume":"41","author":"Berry","year":"2017","journal-title":"Aust N Z J Public Health"}],"container-title":["Injury Prevention"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/ip-2023-044869","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,16]],"date-time":"2025-06-16T07:00:41Z","timestamp":1750057241000},"score":1,"resource":{"primary":{"URL":"https:\/\/injuryprevention.bmj.com\/lookup\/doi\/10.1136\/ip-2023-044869"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,1]]},"references-count":33,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2024,5,20]]},"published-print":{"date-parts":[[2024,6]]}},"alternative-id":["10.1136\/ip-2023-044869"],"URL":"https:\/\/doi.org\/10.1136\/ip-2023-044869","relation":{},"ISSN":["1353-8047","1475-5785"],"issn-type":[{"type":"print","value":"1353-8047"},{"type":"electronic","value":"1475-5785"}],"subject":[],"published":{"date-parts":[[2023,12,1]]}}}