Effect of an Injury Awareness Education Program on Risk-Taking Behaviors and Injuries in Juvenile Justice Offenders: A Retrospective Cohort Study

Background Risk-taking behavior is a leading cause of injury and death amongst young people. Methodology and Principal Findings This was a retrospective cohort study on the effectiveness of a 1-day youth injury awareness education program (Prevent Alcohol and Risk-related Trauma in Youth, P.A.R.T.Y.) program in reducing risk taking behaviors and injuries of juvenille justice offenders in Western Australia. Of the 3659 juvenile justice offenders convicted by the court magistrates between 2006 and 2010, 225 were referred to the P.A.R.T.Y. education program. In a before and after survey of these 225 participants, a significant proportion of them stated that they were more receptive to modifying their risk-taking behavior (21% before vs. 57% after). Using data from the Western Australia Police and Department of Health, the incidence of subsequent offences and injuries of all juvenile justice offenders was assessed. The incidence of subsequent traffic or violence-related offences was significantly lower for those who had attended the program compared to those who did not (3.6% vs. 26.8%; absolute risk reduction [ARR] = 23.2%, 95% confidence interval [CI] 19.9%–25.8%; number needed to benefit = 4.3, 95%CI 3.9–5.1; p = 0.001), as were injuries leading to hospitalization (0% vs. 1.6% including 0.2% fatality; ARR = 1.6%, 95%CI 1.2%–2.1%) and alcohol or drug-related offences (0% vs. 2.4%; ARR 2.4%, 95%CI 1.9%–2.9%). In the multivariate analysis, only P.A.R.T.Y. education program attendance (odds ratio [OR] 0.10, 95%CI 0.05–0.21) and a higher socioeconomic background (OR 0.97 per decile increment in Index of Relative Socioeconomic Advantage and Disadvantage, 95%CI 0.93–0.99) were associated with a lower risk of subsequent traffic or violence-related offences. Significance Participation in an injury education program involving real-life trauma scenarios was associated with a reduced subsequent risk of committing violence- or traffic-related offences, injuries, and death for juvenille justice offenders

An injury awareness education program on outcomes of juvenile justice offenders in Western Australia: an economic analysis

Abstract Background Injury is a major cause of mortality and morbidity of young people and the cost-effectiveness of many injury prevention programs remains uncertain. This study aimed to analyze the costs and benefits of an injury awareness education program, the P.A.R.T.Y. (Prevent Alcohol and Risk-related Trauma in Youth) program, for juvenile justice offenders in Western Australia. Methods Costs and benefits analysis based on effectiveness data from a linked-data cohort study on 225 juvenile justice offenders who were referred to the education program and 3434 who were not referred to the program between 2006 and 2011. Results During the study period, there were 8869 hospitalizations and 113 deaths due to violence or traffic-related injuries among those aged between 14 and 21 in Western Australia. The mean length of hospital stay was 4.6 days, a total of 320 patients (3.6%) needed an intensive care admission with an average length of stay of 6 days. The annual cost saved due to serious injury was $3,765 and the annual net cost of running this program was$33,735. The estimated cost per offence prevented, cost per serious injury avoided, and cost per undiscounted and discounted life year gained were $3,124,$42,169, $8,268 and$17,910, respectively. Increasing the frequency of the program from once per month to once per week would increase its cost-effectiveness substantially. Conclusions The P.A.R.T.Y. injury education program involving real-life trauma scenarios was cost-effective in reducing subsequent risk of committing violence or traffic-related offences, injuries, and death for juvenile justice offenders in Western Australia.</p

Differences in number of traffic offences between before and after road trauma requiring intensive care unit admission.

<p>These results remained unchanged (reduction in number of traffic offences = 1.6, 95% confidence interval 1.1–2.0, p = 0.001) after including only those with at least one traffic offence after their injury.</p

Differences in characteristics and outcomes between those with and without prior traffic offences (N = 10,330).

<p>Note: All continuous data are described in median with quintiles (Q1-4, 20th and 80th percentile). ICU, intensive care unit.</p><p>^#P values generated by Chi square or Mann-Whitney test.</p><p>*426 individuals did not have driver’s licence prior to admission related to motor vehicle trauma.</p><p>**Analysis included only those admitted to the ICU (n = 1360); length of ICU stay was significantly longer among those with prior traffic offences if all patients were included in this analysis.</p><p>Differences in characteristics and outcomes between those with and without prior traffic offences (N = 10,330).</p

Differences in number of demerit points between before and after road trauma requiring intensive care unit admission.

<p>This result remained unchanged (reduction in number of demerit points = 3.7, 95% confidence interval 2.9–4.5, p = 0.001) after including only those with at least one traffic offence after their injury.</p

Factors associated with readmissions to the State Trauma Centre from injury after road trauma among those who recovered from their first injury during the study period (n = 160, N = 10,063).

<p>Note: The proportion of patients correctly classified by model 1, 2, and 3 are all 98.4%.</p><p>Factors associated with readmissions to the State Trauma Centre from injury after road trauma among those who recovered from their first injury during the study period (n = 160, N = 10,063).</p

Flow chart showing inclusion and exclusion of patients for the study.

<p>ICU, intensive care unit.</p

Relationship between cumulative traffic offences demerit points and risk of requiring intensive care unit (ICU) admission or death from road trauma.

<p>Dotted lines delineate 95% confidence interval.</p

Relationships between cumulative number of prior traffic offences, demerit points, or specific types of traffic offences of a licenced motorcycle rider or motor vehicle driver and risk of road trauma leading to intensive care admission or death (n = 1020, N = 7137).

<p>Note: The proportion of patients correctly classified by model 1, 2, and 3 are 85.4%, 84.4%, and 85.4%, respectively.</p><p>Relationships between cumulative number of prior traffic offences, demerit points, or specific types of traffic offences of a licenced motorcycle rider or motor vehicle driver and risk of road trauma leading to intensive care admission or death (n = 1020, N = 7137).</p

Flow chart showing data sources and outcomes of the study subjects.

<p>SD, standard deviation.</p