Reducing injury and risk taking behaviour among adolescents Consensus 06 the final link Australian Resuscitation Council – Qld State Conference 3 June 2006 CRICOS No 00213J Prof Mary Sheehan, Lisa Buckley, Rebekah Chapman

2 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

3 1. The problem of injury

4 Mortality rates from injury: (12 – 24 years) Australia, 1997 (AIHW, 1999) Transport RelatedSuicideInterpersonal violence Males 25.5: 100, : 100,0002.3: 100,000 Females 8.5: 100,0005.9: 100,0001.6: 100,000

5 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)

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 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.)

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 TAFE Police Centrelink Agencies Young people Youth Workers Students (Year 9) Parents/ Guardians Teachers Guidance Officers Other school staff Youth Services Flexible learning programs

10 Research background ‘SPIY’: Skills for Preventing Injury in Youth Research background Adolescent Injury Checklist (Jelalian et al., 1997)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 groupsFocus groups  Year 9 & 12 students from mainstream schools  Disengaged students from Flexible Learning Programs Developmental interviewsDevelopmental interviews  Piloting and debriefing with high school teachers

11 School-based intervention 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 Delivered via Health and PE curriculum by trained teachers Incorporates: Incorporates: First aid: First aid: practical training for dealing with injury situations Peer prevention: group skills and positive peer relationships - Peer prevention: 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 development Professional Development of school staff – focus on protecting adolescents from high risk behaviours and injury through fostering peer skills Professional Development of school staff – focus on protecting adolescents from high risk behaviours and injury through fostering peer skills

13 3. Program content First aid

14 First aid Rationale 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 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% Sprain66%*48% Burn34%35% Concussion/ knocked out14%19% Broken bone11%14% With alcohol First aid Adolescent 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

16 TOP 6 INJURY SITUATIONS EXPERIENCED BY ADOLESCENTS (past 6 months) Injury Situation % of school sample* % of hospital sample** Sports57%51% Fall53%50% Hit by object48%*22% Riding bicycle43%*18% Physical fight42%33% Physically attacked30%22% With alcohol First aid Adolescent 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

17 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 aid Adolescent Injury Checklist findings

18 Risk taking behaviours: motorbike (off-road), bicycle, skateboard, and motor vehicle use Injuries: broken bones, cuts, bruises, grazed limbs, burns, internal injuries First aid Focus 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)”

19 First aid Focus 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)

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: Cuts/bleeding Sprains/strains Burns Fractures/dislocations Head & Spinal injuries Near drowning Drug/alcohol overdose Shock

21 4. Program content Peer 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 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 prevention Protective peer behaviour

24 Peer prevention Psychosocial 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 detail Lesson 2: Resuscitation - Introduction Lesson structure:  Introduction −Review homework from Lesson 1

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

31 Example lesson in detail Lesson 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 detail Lesson 2: Resuscitation - Introduction

33 Example lesson in detail Lesson 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 Risk taking scenario First aidPrevention activity 1 -Intro to DRABCD and detail on Danger Response Brainstorm consequences 2 CreekDetail on Airways, Breathing, CPR Consider alternative actions, Sources of support 3 CreekCPR practice Choking - 4 Underage use of a motor vehicle Stop CPR, Alcohol & drug overdose Influence of friends, Over-estimate drug use

36 Overview of program Risk taking scenario First aidPrevention activity 5 BicycleBleedingNegative impact to self (thoughts) 6 Sports & Bullying FracturePractice alternative less risky behaviour 7 MotorbikeBurns & ShockCognitive restructuring regarding norms 8 Passenger of a drink driver Head & Spinal Injury Problem solve protection of friends