Reducing%20injury%20and%20risk%20taking%20behaviour%20among%20adolescents

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Reducing injury and risk taking behaviour among
adolescents
CRICOS No 00213J
Prof Mary Sheehan, Lisa Buckley, Rebekah Chapman

• Consensus 06
• the final link
• Australian Resuscitation Council Qld State
  Conference
• 3 June 2006

http//www.carrsq.qut.edu.au
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Overview

1. The problem of injury
2. School-based intervention SPIY Skills for
   Preventing Injury in Youth
3. Program content First aid
4. Program content Peer prevention
5. Program process
6. School-based intervention (SPIY) Example lesson
   in detail

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1. The problem of injury
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Mortality rates from injury (12 24
years)Australia, 1997
Transport Related Suicide Interpersonal violence
Males 25.5 100,000 24.0 100,000 2.3 100,000
Females 8.5 100,000 5.9 100,000 1.6 100,000
(AIHW, 1999)
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Youth risk takers

• Individual
• High drinking frequency
• Found pleasure in excitement and danger
• Negative attitudes to authority
• Gender identification (males)

• Parents
• Parental modelling of high risk behaviour

• Peers
• Peers actively involved in risk taking behaviour

High risk taking youth (primarily young males)
Low risk taking youth

• Peers
• Less involvement with peers who engaged in risk
  taking behaviour

• Parents
• Higher parental control/ supervision (females)

• Individual
• Lower disposition to
• risk taking (females)
• Plan ahead consider consequences
• (females)

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2. School-based interventionSPIY Skills for
Preventing Injury in Youth
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Research aim

• The overall goal of the intervention research is
  to reduce injuries among young people (Year 9
  level) that are due to risk taking behaviour

• Risk taking behaviours
• Underage drinking and other substance use
• Underage/unlawful driving
• Riding as passengers of drink drivers
• Interpersonal violence
• Risky motorcycle and bicycle use
• Risky behaviour around water (swimming pools,
  creeks etc.)

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Targets of change

• Knowledge change
• Increase knowledge of injury risk and experience
  and training in relevant first aid
• Attitude changes
• Decrease perceptions that high risk taking peers
  are cool
• Challenge opinion that risk behaviours are cool
• Increase positive attitudes to helping peers
• Encourage positive attitudes to authority
• Challenge the adolescent male notion that you
  have to take risks to be a man or to be cool
• Encourage a sense of belonging in the school
• Behaviour changes
• Decrease the frequency of alcohol use
• Decrease the frequency of high risk behaviours
  injury
• School staff and parents to become actively
  involved in supervision and mentoring
• Increase peer helpful behaviours, including first
  aid

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Agents of change
School District
Flexible learning programs
Students (Year 9)
Other school staff
Parents/ Guardians
Guidance Officers
Teachers
Centrelink Agencies
Youth Services
TAFE
Police
Youth Workers
Young people
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SPIY Skills for Preventing Injury in Youth
Research background

• Adolescent Injury Checklist (Jelalian et al.,
  1997)
• Self report measure with Year 9 students and
  adolescents presenting to hospital emergency
  departments records
• injuries experienced in the past 6 months
• whether injuries resulted in medical attention
• whether injuries occurred in context of alcohol/
  other drug use
• Focus groups
• Year 9 12 students from mainstream schools
• Disengaged students from Flexible Learning
  Programs
• Developmental interviews
• Piloting and debriefing with high school teachers

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School-based intervention SPIY Skills for
Preventing Injury in Youth

• CONTENT
• First aid
• Peer prevention
• Scenario based

• PROCESS
• Teacher led
• Curriculum based
• Informed by best practice

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SPIY Skills for Preventing Injury in Youth

• Curriculum program
• Delivered via Health and PE curriculum by
  trained teachers
• Incorporates
• First aid practical training for dealing with
  injury situations
• Peer prevention group skills and positive peer
  relationships - to increase pro-social peer
  behaviour
• Challenging coolness targeting unsafe male
  identity focus on challenging the male gender
  identification that is associated with risk
  taking
• Teacher development
• Professional Development of school staff
  focus on protecting adolescents from high risk
  behaviours and injury through fostering peer
  skills

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3. Program contentFirst aid
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First aidRationale

• Basic principles
• Acknowledgement that accidents do happen,
  therefore it is appropriate to incorporate
  methods for limiting the outcomes of accidents
  what to do if an accident happens
• Injury deaths may be reduced and the extent of an
  injury minimised if children/adolescents are
  equipped with appropriate skills and knowledge
• Injury Minimisation Program for Schools (IMPS)
  UK
• School Health and Alcohol Harm Reduction Project
  (SHAHRP) Australia
• Do Something! Norway

• Programs all had impact on knowledge, skills,
  self-efficacy, attitudes, and/or intentions to
  perform first aid
• Impact on injury not evaluated

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TYPES OF INJURIES EXPERIENCED BY ADOLESCENTS
(past 6 months)
First aidAdolescent Injury Checklist findings
With alcohol
school sample (base had injury) hospital sample (base had injury)
12-14 25
7 1
10 9
39 29
11 5
Type of Injury of school sample of hospital sample
Cut, bruised or bleeding (Schools 1,2,3 4,5) 83 - 96 94
Sprain 66 48
Burn 34 35
Concussion/ knocked out 14 19
Broken bone 11 14
School sample n722 Year 9 students from five
Qld high schools, mean age 13.6
years Hospital sample n153 adolescents
presenting to Qld hospital EDs, mean age 16.2
years
p lt .01
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TOP 6 INJURY SITUATIONS EXPERIENCED BY
ADOLESCENTS (past 6 months)
First aidAdolescent Injury Checklist findings
With alcohol
Injury Situation of school sample of hospital sample
Sports 57 51
Fall 53 50
Hit by object 48 22
Riding bicycle 43 18
Physical fight 42 33
Physically attacked 30 22
school sample (base had injury) hospital sample (base had injury)
0.3 4
17 21
10 19
10 -
13 31
10 23
p lt .01
School sample n722 Year 9 students from five
Qld high schools, mean age 13.6
years Hospital sample n153 adolescents
presenting to Qld hospital EDs, mean age 16.2
years
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First aidAdolescent Injury Checklist findings

• Most frequently reported injury situations -
  team sports, athletic activities or exercise
  (57 school, 51 hospital participants)
• However 54 school students and 30 hospital
  participants reported at least one transport
  related injury (bicycle, motorcycle, driving,
  passenger, pedestrian)
• Bicycle injuries are the most common transport
  injuries and are particular prevalent among
  high school students (younger adolescents)
• Motorcycle injuries are also quite prevalent
  among school students (19, c.f. 9 hospital
  participants)

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First aidFocus group findings Comments from
high risk youth

• Risk taking behaviours motorbike (off-road),
  bicycle, skateboard, and motor vehicle use
• Injuries broken bones, cuts, bruises, grazed
  limbs, burns, internal injuries

• a mate of mine caught firethe bike was on
  flames
• she had a miscarriage (as a passenger in a
  stolen car that crashed)
• Yeah he got knocked out it was quite funny
  probably (for) about half an hour he was driving
  up (place named) on his motorbike and he got hit
  with a rock. He had his open face helmet. (male)

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First aidFocus group findings Comments from
youth

• Current first aid knowledge
• Carrying mobile
• Going with friends (riding motorbikes off-road)
• Management of cuts and broken limbs

• Expressed needs
• Dealing with intoxication
• Delivered and covers issues relevant to young
  people (age-appropriate)

• Its good to be in, have a friendI wouldnt go
  out by myself on motorbikes, anything could
  happen (male)
• One of the most important skills is probably
  how to deal with people who are like intoxicated
  (female)

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First aid
Aim To teach students practical and immediate
responses for dealing with injury situations

• Delivered via the HPE curriculum using scenarios
• Assessable
• Students receive a certificate of completion and
  are eligible to be assessed for a certificate of
  resuscitation (St John)
• Injuries/conditions covered

Cuts/bleeding Sprains/strains
Burns Fractures/dislocations
Head Spinal injuries Near drowning
Drug/alcohol overdose Shock
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4. Program contentPeer prevention
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Peer prevention

• Aim To change attitudes to risk-taking in the
  peer environment increase protective behaviour
  of peers
• Based on psychological theory (Theory of Planned
  Behaviour, TPB)
• Target behaviour change adolescents reduce
  risk-taking behaviour and support their peers in
  reducing risk-taking

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Peer preventionProtective peer behaviour

• Most studies examine peers negative influence
  (McNamara Barry Wentzel, 2006).
• A study examining peer protective influence found
  one-third of high school students intervened in
  their friends substance use and half in friends
  smoking (Smart Stoduto, 1997).

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Peer preventionPsychosocial factors of change

• Adolescents who dont intervene expect negative
  consequences, especially within their social
  environment (Ulleberg, 2003 Smart Stoduto,
  1997)
• Peer norms play an extensive role in shaping
  adolescent risk-taking behaviour (Scheir
  Botvin, 1997)
• Feeling capable to intervene relates to a higher
  likelihood of intervening (Ulleberg, 2003)

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5. Program process
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Process elements

• Teacher-led
• Curriculum based
• Year 9 Health Physical Education
• 8 x 50 minute lessons
• Informed by best practice
• Theory based cognitive-behavioural strategies
• Interactive discussions based on scenarios
• Personally and culturally relevant

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Process factors affecting successful programs

• Active support from key participants
• Training
• Clear goals
• Integration
• Attractive program
• (Fagan Mihalic, 2003)

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6. School-based intervention (SPIY)Example
lesson in detail
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Example lesson in detailLesson 2 Resuscitation
- Introduction

• Lesson structure
• Introduction
• Review homework from Lesson 1

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Example lesson in detailLesson 2 Resuscitation
- Introduction

• Lesson structure (contd.)
• Introduction
• Present scenario for current lesson creek story

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Example lesson in detailLesson 2 Resuscitation
- Introduction

• Lesson structure (contd.)
• Treatment
• Explanation of DR ABCD (Airway, breathing, CPR,
  defibrillation Danger, response covered in
  Lesson 1)
• Explanation of treatment after near-drowning
• Role play DR AB taking roles from the creek
  story
• Prevention
• Class discussion what could the characters have
  done differently to avoid injury?
• Workbook exercise Wheres the help?

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Example lesson in detailLesson 2 Resuscitation
- Introduction
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Example lesson in detailLesson 2 Resuscitation
- Introduction

• Lesson structure (contd.)
• Conclusion
• Present homework (revision questions DR ABCD)
• Discretionary Material
• Explanation of the bodies reaction to
  near-drowning
• Discussion of the difficulties surrounding
  water-related emergencies
• Followed by
• Lessons 3 Resuscitation (Practice) and 4
  Resuscitation (Additional Skills) allow students
  to practice CPR, learn first aid for choking, and
  consider further issues related to resuscitation
  (drug alcohol overdose stopping CPR)

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Implementation scheduleCase control methodology

• Term 2, 2006 Implementation in intervention
  schools
• Term 2, 2007 Intervention made available to
  control schools
• Intervention schools
• Shailer Park State High School Marsden State
  High School
• Control schools
• Kingston College Bracken Ridge State High
  School Craigslea State High School
• Intervention evaluation
• Pre post design
• Post testing at 3 6 months

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Overview of program
Risk taking scenario First aid Prevention activity
1 - Intro to DRABCD and detail on Danger Response Brainstorm consequences
2 Creek Detail on Airways, Breathing, CPR Consider alternative actions, Sources of support
3 Creek CPR practice Choking -
4 Underage use of a motor vehicle Stop CPR, Alcohol drug overdose Influence of friends, Over-estimate drug use
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Overview of program
Risk taking scenario First aid Prevention activity
5 Bicycle Bleeding Negative impact to self (thoughts)
6 Sports Bullying Fracture Practice alternative less risky behaviour
7 Motorbike Burns Shock Cognitive restructuring regarding norms
8 Passenger of a drink driver Head Spinal Injury Problem solve protection of friends