Adolescent school injuries and classroom sex compositions in German secondary schools

BACKGROUND: School injuries are an important adolescent health problem. Previous research suggests that relevant risk behaviors for school injuries, risk-taking and aggression, are highly susceptible to peer effects. Specifically, evidence suggests that the ratio of men and women in peer groups (sex ratio) affects individuals’ propensity for aggression and risk-taking. However, potential associations of classroom sex ratios with adolescent school injury risks have not been studied so far. The purpose of this paper is to investigate the association of classroom sex compositions with adolescent school injuries. METHODS: We investigate the association of classroom sex ratios with school injuries in a longitudinal survey dataset containing 13,131 observations from 9,204 adolescent students (ages 13-16) from secondary schools in Germany. The data also allow us to identify injuries due to aggressive behavior and analyze these injuries in detail. We use multilevel logistic regression models to analyze risks of both overall and aggression-related school injuries. RESULTS: Adolescent students’ risk for school injuries is significantly and positively associated with male-skewed classroom sex ratios (OR = 1.012, p=0.012). Specifically, the risk of sustaining a school injury increases by 33.5 percent when moving from the 10(th) to the 90(th) classroom sex ratio percentile. Moreover, we find an even stronger positive association between male-dominated classrooms and aggression-related injury risks (OR = 1.022, p=0.010). Compared to classroom sex ratios at the 10(th) percentile, the risk of an aggression-related injury is 78 percent higher in classrooms with a sex ratio at the 90(th) percentile. Finally, we find that both boys’ and girls’ injury risks equally increase with a higher proportion of male students in their classroom. CONCLUSIONS: Our findings indicate that sex composition of classrooms is an important contextual factor for adolescent school injuries, in particular school injuries resulting from aggression. These findings illustrate the need to integrate a contextual perspective on school injuries among adolescent students both into research and into intervention planning. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-021-12370-8.