BACKGROUND:Ambient fine particulate matter (PM2.5) and its chemical components are closely linked to human health, but evidence on their association with violence-related injury remains limited. This study aimed to explore the risk and burden of violence-related injury from short-term exposure to PM2.5 and its chemical components in China. METHODS:Integrating violence-related injury data during 2006-2021 from the National Injury Surveillance System (NISS) of China with PM2.5 components (black carbon (BC), organic matter (OM), ammonium (NH+4), nitrate (NO-3), and sulfate (SO2-4)) data from the Tracking Air Pollution (TAP, https://tapdata.org.cn/), we employed conditional logistic regression to quantify the associations and attributable fractions (AFs) of PM2.5 and its components with violence-related injury. We further conducted stratified analyses to identify vulnerable populations. RESULTS:PM2.5 and its constituents were associated with elevated risk of violence-related injury. Specifically, the excess risks (ERs) for each interquartile range (IQR) rise were 1.97% (95%CI: 1.43-2.51%, IQR: 39.39 µg/m3) for PM2.5, 1.81% (95%CI: 1.30-2.32%, IQR: 7.92 µg/m3) for OM, 1.77% (95%CI: 1.23-2.32%, IQR: 8.84 µg/m3) for SO2-4, 1.73% (95%CI: 1.21-2.25%, IQR: 2.08 µg/m3) for BC, 1.63% (95%CI: 1.14-2.13%, IQR: 9.38 µg/m3) for NH+4 and 1.51% (95%CI: 1.03-1.99%, IQR: 5.92 µg/m3) for NO-3. The associations were stronger for females, students, people aged 45-59 years, those living in Northeast China, and the cold season. The AF of violent injury associated with PM2.5 exposure was 2.53% (95%CI: 1.85-3.20%), with higher AF for OM (AF=2.36%, 95%CI: 1.71-3.01%), followed by BC (AF=2.17%, 95%CI: 1.53-2.81%), SO2-4(AF=2.14%, 95%CI: 1.50-2.78%), NH+4 (AF=1.78%, 95%CI: 1.25-2.30%), and NO-3 (AF=1.55%, 95%CI: 1.07-2.04%). CONCLUSIONS:Short-term exposure to PM2.5 and its constituents elevates the risk and burden of violence-related injury, providing novel evidence for air pollution control and injury prevention policies.

Injury is a major cause of morbidity and mortality among children, yet evidence on the influence of ambient temperature on childhood injury remains limited. This study quantified the association between temperature and child injury across age groups in China from 2006 to 2021 and projected the future burden attributable to temperature under climate change scenarios. Injury data were derived from the National Injury Surveillance System, and meteorological data were obtained from the fifth generation of the European ReAnalysis-Land dataset. Conditional logistic regression combined with distributed lag non-linear models was used to estimate temperature-injury associations, with stratified analyses by sex, injury mechanism, and location. A total of 1,849,211 injury cases among children were included. Temperature showed an approximately linear relationship with injury risk, with a 1.14 % (95 %CI: 1.08 %, 1.20 %) increase in child injury risk for each 1 °C rise. Children aged 2-4 years were most vulnerable, exhibiting a 1.36 % (95 %CI: 1.24 %, 1.48 %) excess risk. Under the SSP5-8.5 scenario, the temperature-attributable fraction for this group is projected to increase from 0.58 % (95 %CI: 0.53 %, 0.62 %) in the 2020s to 6.87 % (95 %CI: 6.27 %, 7.54 %) in the 2090s. Traffic injuries accounted for the largest burden among children aged 0-9 years, while sharp instrument injuries predominated in those aged 10-14 years. These findings indicate that rising ambient temperatures substantially increase childhood injury risk, particularly among younger age groups, and that climate change may amplify the future burden of temperature-related injuries in China.

Fall injury poses considerable disease burden. However, limited studies investigated the age-sex-specific risk and burden of fall injury associated with ambient temperature. A time-stratified case-crossover study with 4.19 million fall injury cases from the National Injury Surveillance System was conducted in China. We identified a U-shaped relationship between temperature and fall injury in the total population, with higher risk from heat than cold. There were significant age-sex-specific disparities in temperature-related fall injury risk, with diminished heat effects and increased cold effects as age rises, particularly among females. Ambient temperature exhibited a substantial burden on fall injuries, with much higher burden associated with heat than with cold across almost all age groups. Compared to the 2020s, our projections indicate a 1.22-fold increase in heat-related attributable fraction (AF) and a 0.38-fold decrease in cold-related AF under the SSP5-8.5 scenario. These findings can guide injury prevention and control strategies in the context of climate change.

Background:Injuries represent a significant public health concern, ranking as the primary cause of mortality among children in China. The 5E strategy is one of the most frequently employed strategies for injury prevention, yet the efficacy of a single prevention strategy is often eclipsed by that of a comprehensive intervention strategy. The present study employed a comprehensive intervention approach, encompassing enhanced supervision, health education and environmental improvement, to evaluate the efficacy of such interventions in preventing injuries among children aged 6-17. Methods:The study population consisted of children aged 6-17 years. A stratified cluster sampling method was adopted to select 6 primary schools, 6 junior schools, and 4 senior high schools from Yuanshi County and Lingshou County respectively, which were then randomly assigned to the intervention group and the control group. The intervention group received a one-year comprehensive injury prevention intervention (January to December 2019), included team-based efforts to strengthen child supervision, with daily visits during school days and weekly visits during holidays; monthly health education sessions on injury prevention; and biannual home-school-community environmental inspections and improvements. The control group received no intervention. Results:The intervention group showed a 0.13% decrease in injury incidence following the intervention, while the control group exhibited a 2.00% increase in injury incidence during follow-up compared to baseline. Analysis using the difference-in-differences method indicated that the intervention reduced injury incidence by 2.13% (95% CI: [0.506, 0.809], p < 0.001). Specifically, children's injury-related knowledge scores increased by 2.830 points (95% CI: [2.659, 3.001], p < 0.001), and their injury-related protective behavior scores improved by 4.573 points (95% CI: [4.308, 4.839], p < 0.001). For parents, injury-related knowledge scores rose by 3.076 points (95% CI:[2.804, 3.347], p < 0.001), and their injury-related protective behavior scores increased by 1.358 points (95% CI: [0.543, 2.174], p = 0.001). No significant changes were observed in injury-related belief scores (children: p = 0.354; parents: p = 0.576) or injury-related risky behavior scores (children: p = 0.961; parents: p = 0.426) among either children or parents. Conclusion:Interventions that integrate childcare, health education and environmental improvements shown a positive impact on the reduction of childhood injuries, the enhancement of injury prevention knowledge, and the promotion of injury prevention behaviors.

Falls represent a significant public health issue world-wide.Previous studies have demonstrated associations of temperature with fall risk,but the effect and burden of hourly relative humidity and fall morbidity have been rarely investigated.Fall data and meteorological data were collected from the National Injury Surveillance System during 2006-2021 in China.Associations between hourly relative humidity and fall onset were analyzed using conditional logistic regression combined with a distributed lag nonlinear model.Stratified analysis was used to identify potential association modifiers.Several sensitivity analyses were applied to examine the robustness of the results.The study involved 4 197 495 fall-related cases.Relative humidity exhibited monotonic relationships with the fall onset risk.The excess risk(ER)of falls appeared immediately at lag 0 h and persisted for 8 h.A 10％decrease in relative humidity was associated with a 1.35％(95％confidence interval[CI]:0.83-1.87％)increase in excess risk of falls and much higher risk for males(ER=1.89％,95％CI:1.29-2.48％)than that for females(ER=0.52％,95％CI:0.14-0.90％).The excess risk of fall injury was the highest among individuals aged 5-14 years(ER=3.45％,95％CI:2.57-4.32％)compared to other age groups.Moreover,compared to the highest relative humidity,the attributable fraction(AF)due to low relative humidity exposure was 4.94％(95％CI:4.88-4.98％).Subgroup analyses revealed that males,individuals aged 5-14 years,students,cases occurring in public places,and cases engaged in sports activities were more susceptible to relative humidity than their correspondents.Regional disparities were observed,with individuals in southern China or warm regions showing greater sensitivity to changes in relative humidity.Results of this study suggest that hourly low relative humidity exposure is associated with an increased risk of fall onset.These findings underscore the necessity of time-specific interventions to mitigate the relative humidity risk.

In the context of global warming, the impact on human health has received increasing attention. However, studies focusing on injury are limited, with most examining temperature-injury association on a daily scale, and the finer temporal variability is unclear. A time-stratified case-crossover study was carried out in 243 surveillance hospitals across China, and ambient temperature was matched to injury cases and controls on an hourly scale. The effects of hourly temperature exposure on injury morbidity were estimated by conditional logistic regressions and meta-analyses, and vulnerable timing and place of injury were further identified. A total of 11,512,467 injury cases were included, with the largest number of cases occurring at 10:00 (1,019,381, 8.85%). The effect of temperature on injury morbidity lasting up to 5 h following exposure, and the cumulative excess risk (CER) of injury increased by 1.04% (95% CI: 0.90%, 1.18%) for each 1 °C rise in hourly temperature. Within a day, temperature-related injury risk peaked at 3:00 (CER = 1.72%, 95% CI: 1.19%, 2.24%), particularly in industrial/construction zones (CER = 1.37%, 95% CI: 1.22%, 1.52%). For injury mechanism, animal-related injury risk was much higher than other injuries across 24 h within a day in all places, especially in industrial/construction zone at 6:00 (CER = 9.37%, 95% CI: 1.12%, 18.30%). The hourly temperatures are acutely associated with an increased risk of injury morbidity, and temperature-related injury risk is more pronounced at nighttime within a day, particularly in industrial and construction zone as well as public place. Our findings provide crucial information for precisely adapting to climate change and reducing injury morbidity.

INTRODUCTION:This study aimed to examine the temporal, spatial and population heterogeneity in the association between temperature and injury by animal in China and to assess the future burden attributed to temperature changes. METHODS:Injury by specific animal data during 2006-2017 and 2019-2021 were obtained from National Injury Surveillance System in China, and meteorological data were obtained from the fifth generation of European ReAnalysis-Land. Conditional logistic regression combined with a distributed lag nonlinear model was applied to investigate the association of temperature with injury by animal. Additionally, we projected future trends in animal-related injury burden linked to temperature changes. RESULTS:This study included a total of 859,321 injury cases by animal. The excess risk (ER) on injury by animal increased 1.57 % [95 % confidence interval (CI): 1.48 %-1.67 %] for a 1°C temperature rise with much higher risk for injury by non-mammalian (ER=7.54 %, 95 %CI: 7.12 %-7.96 %) than that for injury by mammalian (ER=1.75 %, 95 %CI: 1.62 %-1.87 %). Among injury by mammalian, dog bites showed the highest risk (ER=2.01 %, 95 %CI: 1.86 %-2.15 %), while snake injury was most affected by temperature (ER=11.82 %, 95 %CI: 10.44 %-13.21 %) among injury by non-mammalian. We observed significant population heterogeneity with higher ER for male, children < 5 years and farmer. We also observed spatial heterogeneity with higher risk for warm region or southern and central China. Temporally, the top three associations between temperature and animal injury risk were observed in 2009, 2020 and 2010, however, the difference was not statistically significant. Projections indicate that under the SSP585 scenario, the temperature-attributable fraction of animal-related injuries in China will increase by 13.89 % (95 % CI: 9.19 %-18.63 %) in the 2090 s compared to the 2010s baseline. CONCLUSIONS:High temperature significantly increase injury by animal with significant spatial, temporal, population, and animal heterogeneity. Future temperature rise will increase the burden of injury by animal.

BACKGROUND:Temperature-related risks on non-accidental morbidity or mortality have been well documented. However, limited studies have investigated the injury morbidity risk and burden attributed to ambient temperature. OBJECTIVE:The current study aimed to assess the injury morbidity risk and burden attributed to ambient temperature in China. METHODS:A time-stratified case-crossover study was conducted in 31 provincial-level administrations across mainland China, and 11.5 million injury-related emergency department visits recorded in National Injury Surveillance System (NISS) during 2006-2021 were included in the study. An injury case refers to a patient who takes the first visit to the outpatient or emergency department in NISS due to an injury. Daily meteorological data were collected from the fifth generation of European ReAnalysis-Land. A two-stage approach, including a conditional logistic regression and a multilevel meta-analysis, was applied to estimate the temperature-injury association, which were then applied to assess the morbidity burden attributable to temperature. RESULTS:We observed that injury risk increased 1.2% (95%CI: 1.0%-1.4%) for a 1 °C increase in daily mean temperature with higher risk for males, children aged 0-4, and residents in tropical and subtropical zone. We also found that animal injury, violence and attack, and injury in agricultural area were more susceptible to temperature. Compared to the 2020s, we projected 5.7 times increase of injury cases and 10.4 times of attributable fraction due to temperature change driven by global warming in the 2090s under SSP5-8.5 scenario in China. Our findings might be informative for injury prevention in the context of climate change in China. CONCLUSION:Our findings identify susceptible populations, regions and mechanism-specific injuries when exposure to ambient temperature, which could be informative for injury prevention in the context of climate change in China. https://doi.org/10.1289/EHP16878.

Background:Although several studies have demonstrated an association between ambient temperature and injury, the temporal trend of temperature-related injury risk remains unknown. This study aimed to examine changes in the effect of temperature on injury incidence and to explore its driving factors. Methods:A time-stratified case-crossover study including over 11.5 million injury cases from 243 surveillance hospitals in China was conducted, and the injury incidence risks associated with temperature during the periods 2006-2013 and 2014-2021 were compared using conditional logistic regression model combined with distributed lag nonlinear model (DLNM). The socio-economic driving factors of the temporal change from 2006-2013 to 2014-2021 were further explored based on mixed-effects linear model and random forest algorithm. Findings:The study encompassed a total of 11,512,467 injury cases from 2006 to 2021. The temperature-injury incidence relationship was linear, exhibiting a steeper slope between 2006 and 2013 compared to 2014 and 2021. The excess risk (ER) for per 1 °C increase in temperature was 1.08% (95% CI: 1.06%, 1.10%) for 2006-2013, which was significantly higher than the 0.83% (95% CI: 0.82%, 0.84%) for 2014-2021, representing a 23.31% (95% CI: 21.53%, 24.95%) decrease. Among 31 provinces, 74.19% experienced a decline in ER, predominantly in coastal regions. The primary factors influencing this temporal shift in temperature-related injury risk were identified as the child dependency ratio, air conditioners ownership per 100 rural households, and the birth rate. Interpretation:Overall, the risk of temperature-related injuries in China has decreased over the past two decades, with demographic and socioeconomic factors playing pivotal roles in this decline. Funding:National Natural Science Foundation of China.

Objective: To assess the effectiveness of a 6-month Ba Duan Jin exercise program in improving the balance of community-dwelling older adults. Methods: A two arms, parallel-group, cluster randomized controlled trial was conducted in 1 028 community residents aged 60-80 years in 40 communities in 5 provinces of China. Participants in the intervention group (20 communities, 523 people) received Ba Duan Jin exercise 5 days/week, 1 hour/day for 6 months, and three times of falls prevention health education, and the control group (20 communities, 505 people) received falls prevention health education same as the intervention group. The Berg balance scale (BBS) score was the leading outcome indicator, and the secondary outcome indicators included the length of time of standing on one foot (with eyes open and closed), standing in a tandem stance (with eyes open and closed), the closed circle test, and the timed up to test. Results: A total of 1 028 participants were included in the final analysis, including 731 women (71.11%) and 297 men (28.89%), and the age was (69.87±5.67) years. After the 3-month intervention, compared with the baseline data, the BBS score of the intervention group was significantly higher than the control group by 3.05 (95%CI: 2.23-3.88) points (P<0.001). After the 6-month intervention, compared with the baseline data, the BBS score of the intervention group was significantly higher than the control group by 4.70 (95%CI: 4.03-5.37) points (P<0.001). Ba Duan Jin showed significant improvement (P<0.05) in all secondary outcomes after 6 months of exercise in the intervention group compared with the control group. Conclusions: This study showed that Ba Duan Jin exercise can improve balance in community-dwelling older adults aged 60-80. The longer the exercise time, the better the improvement.

Previous studies have demonstrated health impacts of climate change, but evidence on heatwaves’ associations with road traffic injury (RTI) is limited. In this study, individual information of RTI cases in May-September during 2006–2021 in China were obtained from the National Injury Surveillance System. Daily maximum temperatures (TMmax) during 2006–2021 were collected from the ERA-5 reanalysis, and the projected daily TMmax during 2020–2099 were obtained from the latest Coupled Model Intercomparison Project Phase 6 Shared Socioeconomic Pathways scenarios (SSPs). We used a time-stratified case-crossover analysis to investigate the association between short-term exposure (lag01 days) to heatwaves (exceeding the 92.5th percentile of daily TMmax for ≥ three consecutive days) and RTI, and to project heatwave-related RTI until 2099 across China. Finally, a total of 1 031 082 RTI cases were included in the analyses. Compared with non-heatwaves, the risks of RTI increased by 3.61 % during heatwaves. Greater associations were found in people aged 15–64 years, in people with transportation occupation, for non-motor traffic vehicle injuries, for severe RTI cases, and in Western China particularly in Qinghai province. We projected substantial increases in attributable fraction (AF) of heatwave-related RTI in the future, particularly in Western and Southwest China. The national average increase in AF (per decade) during 2020s-2090s was 0.036 % for SSP1-2.6 scenario, and 0.267 % for SSP5-8.5 scenario. This study provided evidence on the associations of heatwaves with RTI, and the heatwave-related RTI will substantially increase in the future.

Background Road traffic injuries (RTI) are the second leading cause of death among children and adolescent aged 1–19 in China. However, effective intervention strategies and mechanisms to protect children from RTI in China are not yet fully understood. Objective The study aims to develop a comprehensive intervention model for RTI prevention and evaluate its effectiveness. The result will be used to inform national policies on RTI prevention. Programme Description This programme was conducted jointly by NCNCD ChinaCDC and UNICEF. A quasi-experimental design was applied to evaluate the effectiveness of interventions. Two counties were designated as the intervention group, and two other counties were selected as the control group. The target population was school-age children. The intervention group received comprehensive intervention measures, including enforcement of regulation, education for awareness and behavior change, and environment modification to reduce risks on the road. The control group did not receive any interventions. Evaluation was conducted based on the baseline survey before and endline survey after one year of intervention. Outcomes and learnings The results indicated a significant decrease in the incidence rate of RTI among school-age children in the intervention group, from 0.88% in the baseline survey to 0.18% in the endline survey. In the control group, the incidence of RTI also decreased, albeit at a lesser rate, from 0.24% in the baseline to 0.11% in the endline. The road safety knowledge score and walking and cycling behavior score also increased significantly in the target group of the intervention group. Cooperation with multiple government departments was critical for the successful implementation of the programme. Implication The comprehensive intervention model for children's RTI has proven effective. The strategies and mechanisms of the interventions can be applied in other areas with similar context in China and provide good practices for other countries to learn. Conclusion The study's findings underscore the effectiveness of the interventions implemented in the study not only in reducing the incidence of RTI among school-age children but also enhancing road safety knowledge and behavior in the two intervention counties. The intervention strategies and mechanisms provided valuable experiences on RTI prevention for other areas.

Objective: To understand the epidemiological characteristics of fatal drowning in children in Zhejiang Province in 2022, analyze factors such as the swimming ability of children, the caregiver behavior at drowning site, types of first aid personnel and methods of first aid of unintentional fatal drowning and provide evidence for targeted intervention. Methods: Using the "Survey Form of Fatal Drowning Case in Children" designed by National Center for Chronic and Non-communicable Disease Control and Prevention of the China CDC, we collected case information of children aged 0-17 years who died due to drowning in Zhejiang in 2022 from medical history/death investigation records, telephone interviews, and home visits. Results: A total of 341 fatal drowning cases in children occurred in Zhejiang in 2022 and 330 cases were investigated (96.77%). The male to female of the cases was 2.33∶1, most cases were aged 15-17 years and 0-4 years, and 54.24% of fatal drowning cases occurred in children from other provinces. In the drowning cases, 83.33% were unintentional ones, and the proportion of intentional fatal drowning cases in children increased with age. Fatal drowning cases mainly occurred in open natural water bodies and public water storage facilities. More fatal drowning cases occurred in open natural water bodies in older children, while more fatal drowning cases occurred in public water storage facilities in younger children. In 275 children who died due to unintentional drowning, 73.09% could not swim, and only 1.09% were fully supervised by adults within an arm's length. First aid personnel, mainly medical staffs, bystanders and adult caregivers, were present for 47.63% fatal drowning cases. The proportion of the cases who had cardiopulmonary resuscitation as the first aid within 5 minutes was 2.18%. Conclusions: Drowning poses a serious threat to children's lives and there are differences in reasons and locations of fatal drowning in children in different age groups in Zhejiang Province in 2022. It is necessary to conduct to interventions to improve children's swimming skills, strengthen effective adult care and conduct health education about field first aid of drowning to reduce the incidence of drowning and related deaths in children.

Although studies have explored the relationship between temperature and CO poisoning, the results are not consistent, and there is still a lack of early warning criteria of temperature related to CO poisoning. In order to comprehensively study the exposure-response relationship between daily average temperature and CO poisoning, and to further explore the early warning criteria of temperature related to CO poisoning, we used daily cases of CO poisoning in 31 National Injury Surveillance System (NISS) surveillance sites in seven administrative geographical regions of China and daily meteorological data obtained from the China Meteorological Science Data Sharing Service Platform from 2009 to 2019 to do the analysis. Daily meteorological data of 698 weather stations across China were interpolated at a 0.01° × 0.01°spatial resolution, which were then applied to extract the daily meteorological data of all included NISS sites. The Distributed Lag Non-linear Model (DLNM) model was applied to estimate the exposure-response associations (relative risk, RR) of daily mean temperature with CO poisoning, which was then further used to identify early warning criteria of temperature related to CO poisoning.A total of 10,618 CO poisoning cases were included in this study, with an average of 0.4 cases per day. There was generally a reverse J-shaped association between temperature and CO poisoning risk, indicating that both low and high temperature may increase the risk of CO poisoning, but low temperature usually has a longer lagged effects than high temperature. Spatialy, the exposure-response associations between temperatue and CO poisoning largely varied among regions, with greater effects of low temperatures in Southern China than in Northern China. The cumulative effects (RR, lag0-6 days) of 10 % percentile temperature ranged from 1.13 (95%CI: 1.01,1.26) in East China to 1.73 (95%CI:1.63,1.83) in South China. We also observed significant spatial variations in the early warning criteria of temperature related to CO poisoning across China. However, the patterns of high temperature effects on CO poisoning and the warning criteria of high temperature were mixed across China. In conclusions, both low temperature and high temperature may increase the risk of CO poisoning in China, and the effect of low temperature is more obvious, especially in South China, Northeast China, and North China. In addition, there is an urgent need to establish air temperature early warning and grading criteria for CO poisoning in different areas of China.

The night-time temperature-related injury risks and burdens were unclear. Using 11,512,467 non-fatal injury cases in 243 surveillance hospitals across China from 2006-2021, we estimated the associations between daytime or night-time temperature and injury by a time-stratified case-crossover study, and compared their injury burden during 1990s-2010s. We found the excess risk (ER) for per 1 degrees C rise in night-time temperature (ER = 1.21%, 95%CI:1.03%,1.39%) was greater than that in daytime (ER = 0.86%, 95%CI:0.72%,1.00%). Compared with the 1980s, the attributable fractions (AFs) for daytime and night-time temperature change during the 1990s-2010s were 0.59% (95%eCI:0.54%,0.67%) and 0.73% (95%eCI:0.69%,0.77%), respectively. Spatially, the higher AFs of night-time temperature were more widely distributed than daytime temperature. The non-fatal injury risk attributed to night-time temperature was stronger than daytime temperature, and increased night-time temperatures posed a heavier injury burden compared with daytime temperature in China. Our findings indicate that high night-time temperature is an important injury risk in the context of climate change.

Introduction:This study seeks to elucidate the evolving trend and identify disparities among subgroups in the mortality rate due to unintentional drowning in individuals under the age of 20 from the timeframe of 2013 to 2021 in China.Methods:Data retrieved from the National Mortality Surveillance System served as a foundation for estimating the unintentional drowning mortality rate. The inadvertent drowning mortality rate for individuals below the age of 20 was computed, differentiated by categorization groups such as age, gender, areas, and regions within each given year. The linear regression model was employed to calculate the annual percent of change (APC) with its 95% confidence interval (CI), providing a depiction of the mortality rate's shifting trend.Results:In 2021, the inadvertent drowning fatality rate for individuals under 20 years of age in China was recorded at 3.28 per 100,000. A steady reduction was observed in the national drowning mortality rate from 6.60 per 100,000 in 2013 down to 3.28 per 100,000 in 2021, signifying a cumulative decrease of 50.30% [APC=-9.06% (95% CI: -11.31%, -6.76%)]. Across all sexes, regions, age groups, and residential areas, a consistent decline in mortality rates was evident between 2013 and 2021.Conclusion:An analysis of the data from 2013 to 2021 reveals a declining trend in the mortality rate due to unintentional drowning among individuals under 20 years of age in China. However, the rate of decline varied when stratified by sex, urban versus rural locations, age-specific groups, and geographical regions.

What is already known about this topic?:Poisoning constitutes a significant cause of mortality among individuals aged 1 to 44 in China. Nonetheless, the epidemiological understanding of poisoning incidents within emergency departments remains fragmented across the region.What is added by this report?:In 2019, the NISS recorded 31,382 cases of poisoning, predominantly among males (62.85%) and individuals aged 25-44 (44.13%). In all poisoning cases, 82.60% were unintentional. The predominant substances exposure in poisoning cases presenting to outpatient and emergency departments were alcohol (56.38%), medications (14.21%), and pesticides (9.78%).What are the implications for public health practice?:This study has shed light on the evidence for nonfatal poisoning prevention to a variety of different groups, and informed special attention needed for high-risk population and substance exposed.

Falls are major health care concerns for older adults. Pain is associated with increased falls in older adults. However, the impact of pain on functional disability and how this might predispose Chinese older adults to fall is unclear. The aim of the current study was to examine whether functional disability mediates the association of any pain, back and/or shoulder pain (B–S pain) and leg and/or knees pain (L–K pain) with falls and serious falls. The study included 7619 community-dwelling older adults aged 60 years and above from the China Health and Retirement Longitudinal Study. Baseline data were from Wave 3 and fall outcomes were from Wave 4. Functional disability was measured by the ADLs and IADLs scales. We used a logistic regression model to investigate associations between pain and fall outcomes and KHB method to estimate the mediating effects of ADL/IADL disability on pain–fall relationship. After fully adjusting for covariates, the three pain measures (any pain, back and/or shoulder pain, leg and/or knees pain) were significantly associated with fall outcomes. When body pain was compared with no body pain, the proportion mediated by the ADL disability was 28.43

Objective To analysis the influencing factors of the use of child safety seats based on the Theory of Planned Behavior, and provide the evidence for further intervention measures.Methods A Probability Proportionate to Size Sampling（PPS） method was used to select 40 kindergartens in 20 communities in Shanghai, 2889 families with children and cars were surveyed.Results The usage rate of child safety seats for children aged 3-6 in Shanghai was 36.17%（95%CI: 34.42%-37.96%）. The use rate of child safety seats was highest in the 3-year-old group（56.41%） and the lowest in the 6-year-old group（29.42%）,the older the children, the child safety seat usage rates were lower.The lower the frequency of family travel, the child safety seat usage rate was lower.The shorter the travel distance of the family, the child safety seat usage rate was lower.The differences above were statistically significant（P＜0.05）. The usage rate of male child safety seats was 36.56%,and that of female children was 35.74%,there was no significant difference in the usage rate of child safety seats for children of different genders.According to the theory of planned behavior, the mediating effect of the influencing factors was analyzed.It was found that authoritative advice and normative beliefs were positive effects on the use of child safety seats, and their total effects were 0.38（z=15.01,P＜0.001） and 0.58（z=26.66,P＜0.001）,respectively.The self-confidence could completely mediated authoritative advice on the use of child safety seats, and the mediating effect was 0.20（z=8.66,P＜0.05）. The self-confidence partial mediated the effect of normative beliefs on the use of child safety seats, and the mediating effect was 0.11（z=8.11,P＜0.05）. The ratio of mediating effect to direct effect was 1 ∶3.10.Conclusion Authoritative advice, normative beliefs and self-confidence are important influencing factors of the use of child safety seats, and self-confidence is the most important factor.

Objective: To investigate the incidence of injuries among children aged 0-17 years from 28 counties in six provinces. Methods: According to the earlier study on data in different local areas and the current work plan, we selected the survey objects for a general survey on child injury prevalence in the last 12 months. The subjects included guardians of children who did not attend kindergartens, children from kindergartens, and primary school grades 1-3. Children from grades 4-6 primary school, junior high school, and senior high school were also included. Results: The overall rate of injured children was 4.83%, with the incidence of injuries as 5.75% in the last 12 months before the survey. Both the rate of injured children and incidence of injuries were higher in boys than that in girls. Children whose primary caregivers were relatives, grandparents, minors, or with an education level below the primary school had a relatively higher rate of both injured children and incidence of injuries. The first cause of child injury was fall. The time of child injury was mainly from June to October, mainly at home, with the main activity as playing. The significant injuries in children were contusion and abrasion, and the main parts injured were lower limbs, upper limbs, and head. Most of the injuries were cured, and the primary treatment was outpatient and emergency treatment. Conclusions: Boys and children whose parents can not take care of are the priority population for child injury prevention and control. Targeted prevention and control measures should be implemented according to the characteristics of injuries among children of different ages.