Accidental injury, risk-taking behaviour and the social circumstances in which young people (aged 12-24) live: a systematic review

In industrialised countries such as England and Wales, unintended injury (which ranges from sprains in sport to hospitalisation and death due to drugs or transport crashes) is the leading cause of death in children aged 0 to 14 years, and a major cause of death in young adults aged 15 to 24. It is also a major cause of ill health and disability in these age groups. There is a large body of research on young people and their perceived propensity to take risks. Common sense suggests that an increased willingness to place oneself at risk will result an increased likelihood of physical injury. However, given that pathways to injury are complex and not always well understood, the UK Department of Health commissioned a large systematic review to examine this multifaceted issue. Drug use • The review found that the use of drugs is associated with an increased risk of accidental death among young people and that 12–24 year olds are less at risk than those immediately older. However, risk of death increases with length of drug use, so there is value in targeting interventions at this age group. • Many more young men than women die from drug overdoses, because more men take drugs, but those women who do use drugs are at higher risk. Certain other groups of young people are more at risk than others. These include young people in deprived areas and men who have recently been released from prison. • There was a clear disjunction of views between young people who used drugs and those who did not. The young people who did not take drugs regarded them as risky and stated that media images about possible negative consequences dissuaded them from trying them, while those who did tended not to believe ‘official’ messages about possible harms and did not perceive taking drugs as being dangerous. Cannabis in particular was singled out as possibly being good for you, with some young people believing it to be cheaper than alcohol. The recent reclassification of cannabis and the subsequent debate may have helped to reinforce this view. • The burden of the more serious injuries – as demonstrated by the mortality statistics – is carried by young people in the lower socio-economic groups. • In road injuries, drugs are found in the bloodstream of more young fatal accident victims than older age groups; however, it is difficult to assess whether drugs actually contributed to the accident. • Driving on cannabis was thought to be more acceptable than drink-driving and not thought to be dangerous. Alcohol use • Almost everyone admitted to hospital for alcohol poisoning is aged between 11 and 17. After a sharp peak among 14 and 15 year olds, hospital admissions for injuries with alcohol involvement decline slowly between the ages of 16 and 30. • Correlational studies have shown that alcohol puts the drinker at an increased risk of injury, that young people are more likely to have injuries than older people, and that young men are more at risk than young women. In the one study that examined ethnicity, minority ethnic status did not increase alcohol-related injuries, and may in fact have had a protective association. • Views studies found that young people say that they do not commonly mix alcohol and other drugs. Most young people reported that drinking places them at greater risk of injury, though some did not. The younger teenagers – 14 and 15 year olds – felt most in danger of injury when drinking. Young people felt that they learned to manage their drinking through experience and that unsupervised, outdoor drinking was the most dangerous and was more common among younger teenagers (with injuries being considered less common in licensed venues). Peers encourage both drinking and drunken pranks, but also protect one another when they have become more vulnerable as a result of drink. Young people felt that drinking reduces their perceptions of danger and some stated that injury as a result was inevitable. Most young people were cautious about getting very drunk, though being sick as a result of drinking is common and not regarded as serious. Bad experiences – whether to self or someone else – might change behaviour in the short- but not long-term. • One study which examined attempts to reduce alcohol-related injuries found some evidence that motivational interviews in A&E departments are more effective than information handouts. Drink-driving • Drink-driving was generally considered dangerous and not socially acceptable, whereas driving on cannabis was more acceptable and not thought to be dangerous. Some young people stated that a lack of public transport (or alternatives, such as taxis) made it more likely that they would drink and drive. • Interventions based on models of behaviour change to reduce drink-driving are ineffective or have a negative effect. Combining different approaches has more effect than using a single approach. Education or skills training has either negative or no effects on driver behaviour and subsequent accidents, possibly because these approaches lead to over-confidence or early licensing. • Legislation and enforcement on reducing drink-driving has been found to be effective

A systematic review of school-based alcohol and other drug prevention programs

Background: Alcohol use in adolescents constitutes a major public health concern. Europe is the heaviest drinking region of the world. Several school-based alcohol prevention programs have been developed but it is not clear whether they are really effective. The present study was aimed at identifying the typology with the best evidence of effectiveness in European studies. Methods: A systematic search of meta-analyses and/or randomized controlled trials (RCTs) on interventions school-based prevention programs aimed at preventing alcohol consumption or changing the attitudes to consume alcohol. Results: A meta-analysis published in 2011 and 12 RCTs more recently published were identified. The meta-analysis evaluated 53 RCTs but only 11.3% of them were conducted in Europe. Globally, 23 RCTs (43.4%) showed some evidence of effectiveness, and 30 RCTs (56.6%) did not find significant difference between the groups. According to the conclusions of the meta-analysis, the Unplugged program should be considered as a practice option in Europe. Among the other 12 RCTs, 42% were conducted in Europe. Globally, 7 studies (58.3%) achieved positive results, and 5 studies (41.7%) did not find significant differences or produced a mixed pattern of results. Three of the 5 European trials (60%) used the Unplugged program with positive results. Conclusion: Even if further studies should be conducted to confirm these results, Unplugged appears to be the prevention project with the best evidence of effectiveness in European studies

Long-Term Follow-Up of a High School Alcohol Misuse Prevention Program's Effect on Students' Subsequent Driving

Alcohol-related injuries, particularly motor vehicle, are an important cause of adolescent mortality. School-based alcohol prevention programs have not been evaluated in terms of driving outcomes. This study examined the effects on subsequent driving of a high school-based alcohol prevention program. Methods : The Alcohol Misuse Prevention Study included a randomized test of the effectiveness of an alcohol misuse prevention curriculum conducted among 4635 10th-grade students. Students were assigned to intervention ( n = 1820) or control ( n = 2815) groups and were followed for an average of 7.6 years after licensure, which typically occurred during or shortly after 10th grade. Outcomes examined included alcohol-related and other serious offenses, and at-fault, single-vehicle, and alcohol-related crashes. Results : Only serious offenses (which included alcohol-related) had a significant treatment effect (statistically marginal) after we adjusted for sex, age, race, alcohol use/misuse, family structure, presence of prelicense offenses, age of driver licensure, and parental attitudes toward teen drinking. The effect was found only during the first year of licensure (estimated adjusted relative risk = 0.80, confidence interval = 0.63–1.01). Two first-year serious offense interactions were found. The positive effect was strongest among the largest subgroup of students, those who were drinking less than one drink per week on average before the curriculum, compared with those who drank more than one drink per week ( p = 0.009). The effect was also stronger for the small subgroup of students whose parents had not expressed disapproval of teens’ drinking, compared with those whose parents had disapproved ( p = 0.004). Conclusions : These findings suggest that a high school-based alcohol prevention program can positively affect subsequent driving, particularly that of students who do not use alcohol regularly. The results highlight the need to start prevention efforts early and extend them beyond the initial exposure to driving. Programs should incorporate the differing backgrounds of the students.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65493/1/j.1530-0277.2001.tb02227.x.pd

Sideffect GamePlan: Development of an alcohol and other drug serious game for high school students using a systematic and iterative user-centred game development framework

Serious games have shown to be effective in improving motivation to learn, knowledge and retention, thus are being increasingly used for alcohol and other drug (AOD) education. This paper outlines the development of an online AOD serious game for in-class use by Australian secondary school teachers for students in Years 9–10. Adapted from Edwards et al. (2018), the seven-step systematic and iterative user-centred development framework included: (1) Forming an expert multidisciplinary design team, (2) Defining the problem and establishing user preferences, (3) Incorporating the evidence base, (4) Serious game design, (5) Incorporating behavioural and psychological theory, (6) Developing a logic model and investigating causal pathways, and (7) User testing. High school students (n = 8), health and physical education teachers (n = 7), and parents (n = 8) were engaged throughout different stages of the development process to inform development and provide feedback on considerations for promoting engagement, acceptability, and usability of the game amongst both students and teachers. Overall, participants rated game acceptability and usability favourably and would recommend the game for learning about AOD. Constructive feedback and suggestions for improvements from user testing sessions were implemented to form the final version of the game and module. The next step is to test Sideffect GamePlan in a simulated classroom environment before piloting in school settings

Social Context and Perceived Norms: Their Relationship to Alcohol Use in an Adolescent Population

Over 1400 public school students in grade 7-12 were surveyed with an anonymous questionnaire to determine the relative ability of the social context scales and the perceived norm scales to explain adolescent alcohol use intensity, frequency of alcohol-impaired driving, and frequency of riding with an alcohol-impaired driver. It was found that during the twelve month period prior to the survey, 54.2% of all students had used alcohol on at least one occasion, 13.8% had driven a motor vehicle under the influence of alcohol, and 41.8% had ridden with an alcohol-impaired driver. A multiple regression analysis showed that the drinking context of Social Facilitation was most closely related to alcohol use intensity. However, Close Friends\u27 Drinking Intensity, Stress Control, and Peer Acceptance, School/Defiance, and Family also had independent relationships with alcohol use intensity. In two separate discriminant analyses, Social Facilitation was the best discriminator of the two driver groups (impaired versus non-impaired), whereas Close Friends\u27 RWID Frequency was the best discriminator of the two passenger groups (riders of impaired drivers versus riders of non-impaired drivers). These findings indicate that effective alcohol abuse prevention programs will have to address the needs adolescents have for socializing and fun, and that a key to reducing alcohol abuse is altering perceptions of normative drinking practices

Spartan Daily, September 11, 1984

Volume 83, Issue 8https://scholarworks.sjsu.edu/spartandaily/7194/thumbnail.jp