"My suspicion is that hazing is very underreported as a cause of injuries, just as domestic violence was," she says. "If health care providers don't consider whether hazing may be a possible factor, they aren't going to ask the questions required to find out about it."
The term hazing refers to unpleasant initiation practices of organizations such as fraternities and sororities, athletic teams, the military and gangs. Hazing activities can range from the merely embarrassing to the dangerous and deadly. While hazing practices have been recorded since ancient times, Finkel notes that hazing trends come and go, often in response to well-publicized hazing injuries and deaths.
Recent decades have seen an increase in reported hazing incidents, with at least 56 associated deaths reported from 1970 to 1999. In a 1999 study of NCAA athletes conducted by researchers from Alfred University, 80 percent of athletes reported "questionable or unacceptable activities as part of their initiation onto a collegiate athletics team," and 20 percent reported being beaten, kidnapped or abandoned.
Among the types of hazing injuries Finkel mentions are beating or kicking to the point of traumatic injury or death, burning or branding, excessive calesthenics, being forced to eat unpleasant substances, and psychological or sexual abuse of both males and females. She notes that reported forms of coerced sexual activity "that can put victims at risk for injuries, sexually transmitted diseases, and pregnancy" are sometimes regarded as "horseplay" rather than as rape.
Finkel also cites alcohol abuse as a significant factor in most hazing incidents. Not only does hazing often feature forced consumption of large amounts of alcohol "something that has led to deaths in several notorious instances" but a 1998 study by the National Intrafraternity Council found that alcohol was present in from 65 to 95 percent of traumatic hazing incidents and was a factor in 80 percent of paralyzing injuries and almost 90 percent of deaths.
Recognizing hazing victims can be difficult for health care professionals because, like domestic violence victims, the patients may hide the true cause of their injuries. Finkel notes that emergency department staff treating those who may be hazing victims should assure patients that they are safe and protected from possible retribution; carry out complete histories and examinations, including gathering possible legal evidence; explain legal options and offer social and psychiatric services; and help patients make reports to law enforcement agencies.
"There are important risk factors to watch out for, such as the patient's age, participation in athletic or military activities, and involvement of alcohol use," says Finkel. "But one of the most important warning signs might be when the patient's explanation seems inconsistent with the injuries or if the story changes; that's when we need to explore more deeply to find the answers. Health care providers need to be in the forefront of awareness and educational efforts about hazing injuries."
The Massachusetts General Hospital, established in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH conducts the largest hospital-based research program in the United States, with an annual research budget of more than $300 million and major research centers in AIDS, cardiovascular research, cancer, cutaneous biology, transplantation biology and photomedicine. In 1994, the MGH joined with Brigham and Women's Hospital to form Partners HealthCare System, an integrated health care delivery system comprising the two academic medical centers, specialty and community hospitals, a network of physician groups and nonacute and home health services.