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Investigating trends and determinants of violence-related injury in England and Wales

Page, Nicholas 2015. Investigating trends and determinants of violence-related injury in England and Wales. PhD Thesis, Cardiff University.
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Abstract

Interpersonal violence is a public health concern in England and Wales. Nationally, over half of all victims of interpersonal violence sustain physical injuries, whilst approximately one-fifth suffer injuries serious enough to require medical treatment. Interpersonal violence therefore places a considerable burden on criminal justice and health service resources. Accurate and reliable data on the extent and correlates of violence at both national and local level are required in order to inform prevention strategies. Despite this, police and crime survey measures of violence have reported contradictory national trends, whilst few studies in England and Wales have examined either correlates of violence-related injury or the mechanisms explaining how such correlates increase risk of sustaining violence-related injury. This thesis presents findings from three studies which aimed to remedy these deficiencies. Firstly, Emergency Department (ED) attendance data were collected from 100 EDs across England and Wales and time series statistical methods employed to detect both national and local trends. Secondly, regional price indices for alcohol were calculated and associations with regional rates of violence-related injury and socioeconomic measures examined. Thirdly, potential mechanisms linking deprivation with increased risk of violence-related injury among adolescents and how these differed according to gender were examined qualitatively. Findings revealed violence-related injury decreased nationally by 6.4% between January 2005 and December 2012. Rates of violence-related injury were shown to be highest among men, 18-30 year olds and those living in the North West of England. Modelling revealed a significant negative association between violence-related injury and the real price of on-trade and off-trade alcohol; in so that a 10% increase in real alcohol price would reduce violence-related ED attendances in England and Wales by over 60,000 per year. Modelling also revealed that poverty and income inequality had the largest impact on rates of violence-related injury. At micro level, adolescent females were shown to be particularly sensitive to the effects of deprivation; poor alcohol regulation by parents and a lack of structured and appealing leisure activities may potentially increase risk of violence-related injury among this cohort. This thesis has shown ED data to be an invaluable tool for investigating trends and determinants of violence-related injury in England and Wales by clarifying national and local trends and identifying risk factors at both macro and micro level. Implications for violence prevention policies that can be drawn from these findings include targeting regions where violence is higher, raising the price of alcohol above inflation, and improving alcohol regulation and leisure opportunities among deprived adolescents females

Item Type: Thesis (PhD)
Status: Unpublished
Schools: Dentistry
Subjects: H Social Sciences > H Social Sciences (General)
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Uncontrolled Keywords: Violence; Injury; Emergency Department; Alcohol Pricing; Deprivation; Adolescents; England and Wales
Funders: Cardiff University School of Dentistry, Cardiff Business School
Date of First Compliant Deposit: 30 March 2016
Last Modified: 12 Oct 2016 03:29
URI: http://orca.cf.ac.uk/id/eprint/75581

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