The Risk Taking Years

1. The Risk Taking Years CYMRC - To identify, address and potentially decrease the numbers of infant, child and youth deaths in New Zealand Nick Baker

3. CYMRC Process – Deaths 28 days to 25th Birthday Database Analysis Literature LCYMRG DHB Child or Youth Death Policy, Strategy, Systems Change CYMRC HQSC Strategic Partners Recommendations Media Public Opinion Ministries Health Minister Ministers

4. N = 5391

5. NZ Mortality by Age Group 1979 - 2010

6. Ref - Table J1 CYMRC Fifth Report

7. Unintentional death rate, by age and gender 2003–2007

9. About 140 Transport Deaths per year 14-25 14% of the population having 33% of transport deaths

10. Typical Stories • Early parenting issues • CYF involvement • Problems at school - disengage • Not connected to parents • Strong influence of peer group • Escalating risk taking • Alcohol, Cannabis • Mental health issues • No one there for them • Disconnected from services • Missed Opportunities to Intervene • Only clearly identified as information linked after death

11. Cause of mortality in youth aged 15–24 years (%), by category of death, 2003–2008 combined (2366 deaths)

12. [R.P.1] Unintentional injury mortality, by age group and injury type 2003–2007 (rate per 100,000)

13. Youth (15-24 years) transport mortality rates per 100,000, by DHB of death, 2003–2007

14. South Island Land Transport Injury Admissions 2006-10

15. Drowning in New Zealand, 2003–2007 by Year of Age

16. Poisoning deaths (unintentional and undetermined intent) by substance and age in children and young people aged 9 to 24 years, New Zealand 2002–2008 (n=103) (draft CYMRC data 2012) Source: CYMRC Data Collection; Numerator Sbstance Group determined following case review of CYMRC data

17. Teens burnt in explosion allegedly sniffing gas

18. Spectrum of Prevention

19. Spectrum of Prevention

20. Quite common for young people to suffer a number of injuries before death – “frequent flyers” Acknowledgment Bronwyn White Injury Prevention Health Promoter - NMDHB PHU

21. Acknowledgment Bronwyn White Injury Prevention Health Promoter - NMDHB PHU

22. Thanks to ACC Lorna Blunt AGE in Years

23. NZ intentional NZ unintentional

24. Behaviours in Motor Vehicles • during the previous month, • 24% driven by someone driving dangerously • 23% rode with drive who had been drinking alcohol • 10% of 17yr olds had driven a car after more than two glasses of alcohol in 2 hrs before driving • more than 26% of students do not always wear a seatbelt when driving or being driven in a car. (Youth 2007)

25. Consequences of Risk Taking • Injury – physical health • Antisocial behaviours • Drugs alcohol tobacco dependency • Violence crime • Poor educational performance • Unwanted pregnancy • Costs • Lost potential • Injury $400,000,000 per annum direct to ACC • Crime

26. Risk Taking • Active voluntary behaviours associated with high risk of injury or death • Different sorts of risk taking cluster • Across life domains, reckless use of vehicles, natural hazards, alcohol, sex, violence, crime, drugs • OECD uses teen births, youth smoking and drunkenness as national index of risk taking • NZ 24th out of 30 OECD countries • Consequences can have major impact on future potential

27. Risk Taking -Developmental Determined • An evolutionary advantage? • Risk seeker – hero Risk avoider – coward • Greater chance of success if resources are scarce • males competing for a mate, finding new food sources • Strong decision making under uncertainty • Risk takers who survive may get high rewards • Criminals, stock markets, racing car drivers • Now imbedded in youth phenotype • a need for the stimuli risk taking creates • experiences that cross boundaries attractive to adolescents • risk taking leads to acceptance within peer group • rebellion and differentiation from adult norms

28. Safe Timid Out-going Faint-hearted Fearful Diffident Hesitant Nervous Anxious Apprehensive Careful Circumspect Far-sighted Wary Prudent Sensible Pioneer Adventurer Plucky Brave Bold Daring Fearless Courageous Impulsive Overconfident Impudent Irresponsible Foolhardy “A true hero knows when to be a coward!” Risk Avoider Risk Seeker coward hero Wise Reckless Dangerous

29. Risk Taking • Environmentally potentiated • Social, physical, emotional • Isolation from moderating mature influence • Hazards increased by • Opportunities – fast cars, dangerous rivers • Alcohol • Peers • Media – you-tube, video games, violent programs promote violence? • Disconnection – parents matter still

30. Alcohol • Alcohol contributes to • 1: 3 injury deaths (15-24yr age group) • More fatal crashes in the 15–24 age than older groups • a greater effect on driving performance at lower levels for young people ( + peers!) • Do not set young people up to learn to drink at same time as learning to drive • Zero tolerance for alcohol in young & novice drivers • The greatest risk period for young drivers is in the first six months of driving solo – graduated licence

31. Through the Eyes of a Child?

32. NZ Injury Deaths 2005-07 n=357

33. What do we know works? • Telling young people about risk • Telling young people what to do • Explore why they might change target behaviour • HUGE international disparities suggest substantial change is possible • Environmental, enforcement, legislation • Building Risk Competence • Need specific youth targeted interventions across all risk taking and injury types

34. Building Risk Competence • learn to manage complex and hazardous situations and avoid harm • develop emotional, social and cognitive -resilience • improve • perception and assessment of risks • coping with hazardous situations • opportunities and environments • explore and develop • physical, psychological, social skills without undue injury risk – “split the risk”

35. Kaikohe unicyclists aim for the top Exceptional Efforts from Exceptional People How do we make it easier?

36. Risk Competence Lower Greater Experience – transferability Practiced decision maker Perception of Risk Values and Attitudes Sense of control Mentoring Supervision Connections Purpose Learn from Mistakes • Novice • Peer presence • Males • Disconnected • Alcohol • Drugs • Aimless • Mental illness • ADHD • Disability

37. Building Risk Competence • Communities should • reduce pathways to harm with more opportunities for healthy development - without death! • link environments of risk to support & supervision • Joined up services support holistic care • Role modelling • separate alcohol and sport • Support parents to understand role and stay connected

38. Mitigate Impact of Risky Behaviours • Environmental modification • road designs, urban design • Product modification • car design, air bags • Legislation, regulation and enforcement • legal limits for alcohol, graduated licensing • Use of safety devices • seat belts, condoms • Community-based interventions • mentoring, youth workers, employment Passive

39. Youth Specific Prevention • 15-24 yr issues lost in adult issues and injury type specific interventions • Same factors contribute to • Vehicle, workplace, drowning, poisoning, assault • No group with focus on youth injury - cfSafeKids • Developmental preventive interventions • Need a common national approach • Lead agency injury prevention 14-24 or 0-19?

40. The Role of Health Care • Supporting Young People • Connections communication – motivational interviews • Recognise risk and intervene – ADHD repeats • Develop care pathways – brief counselling • Supporting Parents • Stay connected – explore why change target behaviour • Anticipatory guidance – understand the risks • Community Change • Youth at the centre • environmental and attitude change

41. Acknowledgements • CYMRC Workforce • Local & National Coordinator • Local Groups and Chairs • 500 plus Agents – Police, CYF, Plunket, St Johns, MOE • DHBs • Coroners • HQSC secretariat • Gabrielle MacDonald and Mortality Data Group • Bronwyn White NMDHB ED data • Lorna Blunt ACC data