Modifiable behavioral and environmental risks for childhood injury among young children

Behavioral and environmental risk exposure data are critical for child injury prevention, yet routine surveillance rarely collects such data. Using baseline data from a large cluster RCT conducted in China, we report prevalence rates of behavioral and environmental risks for child injury.

Children aged 0-5 years were recruited between August 2024 and February 2025 from 12 streets/towns in Changsha, China, through local primary health care institutions in both urban and rural areas. Caregivers completed a WeChat-based questionnaire on socio-demographics and 46 behavioral and environmental child injury risk factors. We calculated composite scores for behavioral risk and environmental risk separately and dichotomized at the 66.7th percentile. Adjusted prevalence ratios (aPRs) were estimated using Poisson regression models with robust standard errors.

Among 6,701 children aged 0-5 (53.0% boys; 64.1% aged 3-5 years; 59.5% urban), composite behavioral and environmental risk scores were right-skewed, with exposure of specific risk factors ranging from 0.4% to 85.2%. Common risks included infant bed-sharing (85.2% among infants), non-use of child restraint systems (CRS) (34.7%), and climbing or jumping on beds or furniture (29.8%). Compared with infants, children aged 1-2 and 3-5 years had lower behavioral risk (aPR = 0.87, 95%CI: 0.78-0.98 and aPR = 0.90, 95%CI: 0.82-1.00) and lower environmental risk (aPR = 0.75, 95%CI: 0.66-0.86 and aPR = 0.78, 95%CI: 0.70-0.87). Boys (aPR = 1.15, 95%CI: 1.08-1.24) had higher behavioral risk than girls. Rural children had lower behavioral risk (aPR = 0.84, 95%CI: 0.77-0.91) but higher environmental risk (aPR = 1.42, 95%CI: 1.29-1.56).

Several risky behaviors and hazardous environmental exposures are common among young Chinese children. Targeted injury prevention interventions are recommended.

This study provides a comprehensive overview of modifiable injury risks for children aged 0-5 in China. The findings highlight the most prevalent hazards and can inform evidence-based interventions and resource allocation.