Reducing injury and risk taking behaviour among adolescents

1. CRICOS No 00213J Reducing injury and risk taking behaviour among adolescents Consensus 06 the final link Australian Resuscitation Council – Qld State Conference 3 June 2006 Prof Mary Sheehan, Lisa Buckley, Rebekah Chapman http://www.carrsq.qut.edu.au

2. Overview • The problem of injury • School-based intervention: ‘SPIY’: Skills for Preventing Injury in Youth • Program content: First aid • Program content: Peer prevention • Program process • School-based intervention (SPIY): Example lesson in detail

3. 1. The problem of injury

4. Mortality rates from injury:(12 – 24 years)Australia, 1997 (AIHW, 1999)

5. 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)

6. 2. School-based intervention‘SPIY’: Skills for Preventing Injury in Youth

7. Research aim • The overall goal of the intervention research is to reduce injuriesamong 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.)

8. 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

9. 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

10. ‘SPIY’: Skills for Preventing Injury in YouthResearch 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

11. 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

12. ‘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

13. 3. Program contentFirst aid

14. 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

15. First aidAdolescent Injury Checklist findings TYPES OF INJURIES EXPERIENCED BY ADOLESCENTS (past 6 months) With alcohol ^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 *p < .01

16. First aidAdolescent Injury Checklist findings TOP 6 INJURY SITUATIONS EXPERIENCED BY ADOLESCENTS (past 6 months) With alcohol *p < .01 *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

17. 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)

18. 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 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)”

19. 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) • “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)

20. 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:

21. 4. Program contentPeer prevention

22. 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

23. 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).

24. Peer preventionPsychosocial 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)

25. 5. Program process

26. 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

27. Process factors affecting successful programs • Active support from key participants • Training • Clear goals • Integration • Attractive program • (Fagan & Mihalic, 2003)

28. 6. School-based intervention (SPIY)Example lesson in detail

29. Example lesson in detailLesson 2: Resuscitation - Introduction • Lesson structure: • Introduction • Review homework from Lesson 1

30. Example lesson in detailLesson 2: Resuscitation - Introduction • Lesson structure (contd.): • Introduction • Present scenario for current lesson – creek story

31. 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 – Where’s the help?

32. Example lesson in detailLesson 2: Resuscitation - Introduction

33. 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)

34. Implementation schedule:Case 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

35. Overview of program

36. Overview of program