Unintentional Injury. Intentional Injury Female Genital Cutting

Experimentation is a normal part of adolescent develop­ment, as teenagers learn more about the world around them. The desire to challenge authority, gain peer approv­al, and try out mature roles causes youth to engage in risky behavior. As a result, young people, especially young men, are at the highest risk for disease and death due to unintentional injury.

In the United States, unintentional injuries are the lead­ing cause of death for young people; the Centers for Disease Control and Prevention determined that motor vehicle crashes cause one-third of all deaths for this group (National Center for Injury Prevention and Control, 2006). Other industrialized countries have similar epidemiologic pat­terns. Adolescent drivers, especially males, while lacking experience and skill, are more likely to be impulsive, pay poor attention, and speed while they drive.

Many motor vehicle crashes involve drug or alcohol use, which further impairs judgment. Accidents most commonly occur on weekends, at night, with multiple passengers in the vehicle, which can easily distract teenagers. Minimum driving ages, graduated driving programs, curfews, and limitations on the number and age of passengers an adolescent can have in the vehicle have improved driving safety in some areas. Improvements in general driving safety, such as mandatory seatbelt laws and enforcement of blood alcohol limits, have also benefited young drivers. Helmet laws may also help prevent closed head injury for those youth who ride mopeds and motorcycles.

In the developing world, injuries are increasingly a major contributor to morbidity and mortality as infectious diseases are becoming better controlled. Most motor vehi­cle deaths worldwide occur in males living in low- and middle-income regions, a large portion occurring in the West Pacific and Southeast Asia. As economies improve, societies become more mobile and youth have the finan­cial resources to purchase automobiles. Injuries incurred while driving usually involve poorly maintained roadways and carrying overloaded vehicles with multiple passen­gers. Improved conditions of highways and standards for vehicle performance have helped reduce mortality in some areas.

Drownings are another cause of death among young people worldwide; these injuries similarly often involve alcohol use. Inebriated teenagers may be more likely to sustain head injury while diving, or they may overestimate their swimming skills. Youth in developing countries are at higher risk for burns and poisonings. Young people in industrialized regions also risk injury while participating in recreational activities. In particular, sports such as skiing and football confer a higher risk of head injury. Mandatory use of protective equipment such as helmets has helped protect young people from injuries that could cause paralysis or death.

Intentional Injury Female Genital Cutting. Female genital cutting (FGC) is commonly performed in regions in Africa and the Middle East, with or without girls’ consent. It is estimated that 130 million girls and women have had the procedure, in which the structures of the genitals are destroyed under frequently unsanitary conditions with instruments such as rocks or glass.

The extent of the mutilation varies. Most girls are forced to have the painful procedure while being held down with­out the benefit of analgesics. Usually occurring during childhood and early adolescence, some young women have FGC before they are married or experience some other major life event. FGC has long-lasting psychologi­cal and physical effects. Many suffer lifelong sexual dys­function; menstrual, urinary, and obstetric obstruction risking infection and death; massive hemorrhage; and shame from the trauma.

War. In many developing countries, war is a significant force shaping the lives of adolescents. Young men are targeted to be recruited to join militias, as youth are more mallea­ble and susceptible to authority. Adolescents are more likely to hold the lowest rank and fight on the front lines. They may lose their life in battle or be permanently injured or disabled.

After witnessing or participating in the violence of war, youth are frequently psychologically damaged, and are more vulnerable than adult soldiers to posttraumatic stress disorder (PTSD). Adolescents with PTSD often have interpersonal problems and struggle to subsequently function in the workplace. Young women and men alike make up a large proportion of refugees, often losing out on their education, while ties to their families and communities dissolve.

Violence. Physical abuse is a common phenomenon in adolescents. Accurate data are lacking due to underreporting. In many cultures, females are expected to be subservient to males; domestic violence may be accepted or ignored. Battering a young woman may be proof of a man’s machismo, and is a major cause of death among females. Young women may be a victim of violence by their romantic partner or a family member, or may witness their mother’s abuse.

In the United States, one-third of adolescents report vio­lence within the context of dating relationships. Dating violence is more common than previously thought in younger teens, is associated with other unsafe behaviors such as alcohol and unprotected sex, and may play an important role in establishing expectations and patterns in adult relationships. Teenagers lack the financial resources and maturity to be able to leave an abusive environment. Young gay men are more likely to be assaulted by their peers; other minorities may also be victims of hate crimes.

The role of the media has been increasingly evaluated as a factor in adolescent violence. Children in many industrialized countries witness countless violent acts in movies and television; physical aggression is often por­trayed as enjoyable, a sign of masculine power, or an immediate response to a situation where a person was wronged. Easy access to guns in places such as the United States has caused many altercations to become deadly.

Adolescents are particularly vulnerable to the negative psychological effects of physical abuse as their personal­ities are in the process of development; they are more likely to suffer anxiety and poor self-esteem due to self­blame and guilt. Many teenagers who have been abused have multiple physical complaints such as abdominal pain or headaches, and visit medical providers repeatedly. These youth are more likely to fail academically, drop out of school, and abuse substances. They are also more likely to continue a pattern of physical violence in their romantic lives as adult victims or as perpetrators.

Gangs have become increasingly problematic in the industrialized and developing world. Gangs offer vulner­able young people who may have a bleak academic and economic outlook a close-knit social network and oppor­tunity to have an income. Youth in gangs commonly steal property, deal drugs, commit violent crimes, and have access to weapons. Warfare between gangs kills and maims many young men every year, helping to make homicide the leading cause of death among young men in many countries, especially in the Americas. Homicide is more common among young men than any other age group in most regions worldwide.

Adolescents who engage in physical violence are more likely to be arrested and spend time in juvenile detention centers or adult jails. During this time, they may lose out on educational opportunities and can become further isolated from appropriate role models as healthy social ties are weakened. Teenagers who are jailed in adult facil­ities may be abused by older men; some evidence shows that they may be more likely to continue a life of crime.