Reducing injury and risk taking Reducing injury and risk taking behaviour among adolescentsbehaviour among adolescents

Consensus 06the final link

Australian Resuscitation Council – Qld State Conference3 June 2006

CRICOS No 00213J

Prof Mary Sheehan, Lisa Buckley, Rebekah Chapman

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

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OverviewOverview

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

(AIHW, 1999)

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

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Youth risk takers

Low risk taking youth

High risk taking youth(primarily young males)

Peers•Peers actively involved in risk

taking behaviour

Parents•Parental modelling of high risk

behaviour

Individual•High drinking frequency

•Found pleasure in excitement and danger

•Negative attitudes to authority•Gender identification

(males)

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 intervention‘SPIY’: Skills for Preventing Injury in Youth

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Research aimResearch 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 changeTargets of change

Knowledge change:Knowledge change:• Increase knowledge of injury risk and experience and training in relevant first aid

Attitude changes: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: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

TAFEPolice

Centrelink Agencies

Young people

Youth Workers

Students (Year 9)

Parents/ Guardians

TeachersGuidance Officers

Other school staff

Youth Services

Flexible learning programs

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‘SPIY’: Skills for Preventing Injury in Youth Research backgroundResearch background

• Adolescent Injury Checklist Adolescent Injury Checklist (Jelalian et al., 1997)(Jelalian et al., 1997)

Self report measure with Year 9 students and adolescents presenting to Self report measure with Year 9 students and adolescents presenting to hospital emergency departments; records:hospital emergency departments; records:

− injuries experienced in the past 6 months; injuries experienced in the past 6 months; − whether injuries resulted in medical attention; whether injuries resulted in medical attention; − whether injuries occurred in context of alcohol/ other drug usewhether injuries occurred in context of alcohol/ other drug use

• Focus groupsFocus groups Year 9 & 12 students from mainstream schoolsYear 9 & 12 students from mainstream schools Disengaged students from Flexible Learning ProgramsDisengaged students from Flexible Learning Programs

• Developmental interviewsDevelopmental interviews Piloting and debriefing with high school teachersPiloting and debriefing with high school teachers

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School-based interventionSchool-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 programCurriculum program• Delivered via Health and PE curriculum by trained teachersDelivered via Health and PE curriculum by trained teachers• Incorporates: Incorporates:

• First aidFirst aid:: practical training for dealing with injury situations • Peer prevention: Peer prevention: group skills and positive peer relationships -group skills and positive peer relationships - to increase pro-social peer behaviour• Challenging ‘coolness’Challenging ‘coolness’:: targeting unsafe male identity – focus on challenging the male gender identification that is associated with risk taking

Teacher developmentTeacher development• Professional Development of school staff – focus on protecting adolescents Professional Development of school staff – focus on protecting adolescents from high risk behaviours and injury through fostering peer skillsfrom high risk behaviours and injury through fostering peer skills

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3. Program contentFirst aid

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First aidFirst aidRationaleRationale

• 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)TYPES OF INJURIES EXPERIENCED BY ADOLESCENTS (past 6 months)

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%

With alcohol

First aidFirst aidAdolescent Injury Checklist findingsAdolescent Injury Checklist findings

^School sample: n=722 Year 9 students from five Qld high schools, mean age = 13.6 years

^^Hospital sample: n=153 adolescents presenting to Qld hospital EDs, mean age = 16.2 years

% school sample (base:

had injury)

% hospital sample (base:

had injury)

12%-14% 25%

7% 1%

10% 9%

39% 29%

11% 5%

*p < .01

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TOP 6 INJURY SITUATIONS EXPERIENCED BY ADOLESCENTS (past 6 TOP 6 INJURY SITUATIONS EXPERIENCED BY ADOLESCENTS (past 6 months)months)

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%

With alcohol

First aidFirst aidAdolescent Injury Checklist findingsAdolescent Injury Checklist findings

*School sample: n=722 Year 9 students from five Qld high schools, mean age = 13.6 years

**Hospital sample: n=153 adolescents presenting to Qld hospital EDs, mean age = 16.2 years

% school sample (base:

had injury)

% hospital sample (base:

had injury)

0.3% 4%*

17% 21%

10% 19%

10% -

13% 31%*

10% 23%

*p < .01

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• 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)

First aidFirst aidAdolescent Injury Checklist findingsAdolescent Injury Checklist findings

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• Risk taking behaviours: motorbike (off-road), bicycle, skateboard, and motor vehicle use

• Injuries: broken bones, cuts, bruises, grazed limbs, burns, internal injuries

First aidFirst aidFocus group findings: Comments from high risk youthFocus group findings: Comments from high risk youth

“a mate of mine caught fire…the 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 aidFirst aidFocus group findings: Comments from youthFocus group findings: Comments from youth

“It’s good to be in, have a friend…I wouldn’t 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)

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)

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First aidFirst aid

Aim:Aim: To teach students practical and immediate responses for dealing To teach students practical and immediate responses for dealing with injury situationswith 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: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 preventionPeer prevention

Aim:Aim: To change attitudes to risk-taking in the peer environment & increase To change attitudes to risk-taking in the peer environment & increase protective behaviour of peersprotective 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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• 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).

Peer preventionPeer preventionProtective peer behaviourProtective peer behaviour

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Peer preventionPeer preventionPsychosocial factors of changePsychosocial factors of change

• Adolescents who don’t 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 elementsProcess 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 programsProcess 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 detailExample lesson in detailLesson 2: Resuscitation - IntroductionLesson 2: Resuscitation - Introduction

• Lesson structure: Introduction

− Review homework from Lesson 1

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Example lesson in detailExample lesson in detailLesson 2: Resuscitation - IntroductionLesson 2: Resuscitation - Introduction

• Lesson structure (contd.): Introduction

− Present scenario for current lesson – creek story

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Example lesson in detailExample lesson in detailLesson 2: Resuscitation - IntroductionLesson 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 – Where’s the help?

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Example lesson in detailExample lesson in detailLesson 2: Resuscitation - IntroductionLesson 2: Resuscitation - Introduction

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Example lesson in detailExample lesson in detailLesson 2: Resuscitation - IntroductionLesson 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

emergenciesFollowed 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 schedule:Implementation schedule:Case control methodologyCase control methodology

Term 2, 2006: Implementation in intervention schoolsTerm 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 programOverview 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 programOverview 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