School injuries in an occupational health perspective: what do we learn from community based epidemiological studies?

OBJECTIVE The paper reviews community based epidemiological studies of injuries at school. It discusses their main findings in the light of a frame of analysis that emphasizes multidimensionality of causes, and in a Swedish context, where school injuries are legally regarded as occupational injuries. METHODS A frame of analysis, inspired by research in the arena of occupational accident, was developed. It employs four key concepts to distinguish between injury and accident sequence, and between situational and structural factors as potential injury determinants. It also stresses the interaction between pupil, school, and community, in injury genesis. In parallel, a review of community based epidemiological studies of school injuries was undertaken after searching the relevant literature. The knowledge gathered from these studies is appraised in the light of the frame of analysis. RESULTS In general, the studies point to potential risk groups, and to hazardous locations and activities. They address injury characteristics, but largely fail to define typical mechanisms. The literature sheds little light on whether there are particular characteristics of the community, school, or pupil(s)--other than gender and age--that influence injury event occurrence. CONCLUSIONS Further research should devote attention to the sequences of events culminating in school injuries, and to the structural determinants of accident sequences. In this, surveillance systems might prove to be of great utility.