The teens who die in motor vehicle crashes are passengers 86 percent of the time, but in 68 percent of those crashes, the driver is also a teenager. Alcohol is a significant factor when teens are killed in motor vehicle crashes, with more than half of the teenaged victims found to have blood alcohol levels 0.1 mg/dL or greater (Jones et al. 1992).

Intentional Injuries

Homicide and suicide mortality rates increase as children move through adolescence, with greater than an eight-fold difference between the younger and older adolescent groups for homicide and about seven-fold difference for suicide. Among 10- to 14-year-olds, homicide was the third leading cause of death in 1999, and suicide ranked fourth. For those aged 15 to 19, homicide was the second leading cause of death with suicide ranking third. The majority of suicide and homicide deaths in both age groups were linked to firearms (NCHS, 2001e).

Malignant Neoplasms

Adolescents tend to suffer from different types of cancers than younger children (Ries et al., 1999). Embryonal cancers (e.g., neuroblastoma, Wilms’ tumor) are uncommon cancer diagnoses in this age group; germ cell cancers (e.g., testicular cancer) are more common. In 1995, the top four causes of cancer mortality in 10- to 14-year-olds were leukemia, brain and central nervous system (CNS) tumors, bone and joint tumors, and non-Hodgkin’s lymphoma (Ries et al., 1999). In 15- to 19-year-olds, the top causes of mortality due to malignant neoplasm were brain and CNS tumors, leukemia, bone and joint tumors, sarcomas, and non-Hodgkin’s lymphoma.

Overall, malignant neoplasms are the second leading cause of death in 10- to 14-year-olds and the fourth leading cause of death in 15- to 19-year-olds. The cancer death rate is, however, slightly higher in the older teens than in the younger group (3.8 per 100,000 versus 2.6 per 100,000 in 1999) (NCHS, 2001b). Between 1973 and 1992, the incidence of cancer rose the most and the death rate decreased the least in the 15- to 19-year age category compared to any other child or adult age group (Bleyer et al. 1997).

GENDER, SOCIOECONOMIC, AND OTHER DIFFERENCES AND DISPARITIES IN CHILD MORTALITY

Whether the objective is preventing deaths or planning programs to improve palliative and end-of-life care for children and their families, one useful step is examining demographic and other data for risk factors or



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