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

Childhood obesity and educational attainment : A systematic review

Background This report describes the findings and methods of a systematic review of research which explores the relationship between obesity and educational attainment. It has been conducted at a time of great concern about levels of obesity in the UK, and the negative physical, psychological and social impacts of obesity. Current research suggests that there may be a relationship between obesity and poor educational attainment. It is likely that obesity and poor school performance are elements of a broader picture of inequalities in health and education, whereby disadvantaged socio-economic groups tend to have poorer health and lower levels of education. However, it is possible that other factors influence obesity and attainment, such as gender, discrimination and poor mental and emotional well-being. This systematic review was therefore commissioned to address the question: What do we know about the relationship between childhood obesity and educational attainment, from the research literature? In order that our review might be informed by those closest to observing any interaction between obesity and attainment, we sought the perspectives of teachers and young people to identify the causal pathways that seemed most pertinent to them. Findings Is there a statistical association between obesity and educational attainment? While often conflicting, an overall pattern emerges from the research evidence suggesting that there is a weak negative association between obesity and educational attainment in children and young people; i.e. that higher weight is associated with lower educational attainment. Obesity is also associated with other variables, such as socio-economic status, and when these other variables are taken into consideration, the association between obesity and attainment becomes still weaker, and often loses statistical significance. To what extent does the research evidence explore the influence of the broader determinants of health, and in particular socio-economic position, in explaining any link between obesity and attainment? Place of residence, ethnicity, occupation, gender, religion, education, socio-economic status (SES) and social capital were all explored as potential moderating variables in the included research. Twenty-three of 29 studies used a measure of socio-economic status as a moderating variable. Various factors appear to contribute to low educational attainment to some extent, although given the variation in definitions, analyses and quality of data, it is impossible to point to any causative or definite risk factors. Authors of the included studies have posited theories suggesting that the link between obesity and educational attainment is moderated by individual and societal factors. Does the research evidence support or refute these? Most studies explored the influence of obesity upon attainment. Only two studies examined the influence of attainment upon obesity. Many authors suggested multiple causal pathways, many of which remained untested in their studies. The moderating variables used in statistical analyses of the relationship between obesity and attainment were not consistent with the causal pathways proposed, which is probably a reflection of the constraints imposed upon authors conducting secondary analyses of pre-existing datasets (i.e. they made use of existing variables, rather than collecting their own, tailored data). The most frequently cited factors resulting from obesity and impacting upon educational attainment were poor mental health, stigmatisation and discrimination, disordered sleep, decreased time spent in physical activity and socialising, and absenteeism. Different perspectives on obesity and attainment Few young people initially thought that obesity and educational attainment were associated. However, they considered obesity and educational attainment to be of importance to young people. Young people considered parental influence and circumstances, including family income and poverty, and bullying and emotional health to be the most important factors which might explain an association between obesity and educational attainment. Most teachers said that there was an association between obesity and educational attainment. Bullying, low self-esteem and emotional well-being, poverty and poor diet, and physical activity were commonly cited by teachers as being the most important and credible mediating variables in this association. Teachers also considered gender, ethnicity and parental influence to be important factors. While researchers, teachers and young people identified causal pathways whereby low academic attainment resulted from poor mental and emotional health among obese children and young people, only four studies adjusted for mental and emotional health variables. This may represent a significant divergence in the perspectives of researchers and stakeholders. Alternatively, it may be that in the 23 studies which conducted a secondary analysis of an existing dataset, such data were not available to the authors. Another divergence concerns the impact of reduced participation in sports and social activities. While teachers and young people located this within a broader framework of isolation and lower socialisation suffered by obese children – and thus felt reduced sports participation would result in lower attainment – three studies in the included research proposed a causal pathway in which reduced participation in sports and social activities might lead to increased time spent studying and hence higher attainment

Nurses', physicians' and radiographers' perceptions of the safety of a nurse prescribing of ionising radiation initiative: A cross-sectional survey

Background: A new initiative was introduced in Ireland following legislative changes that allowed nurses with special training to prescribe ionising radiation (X-ray) for the first time. A small number of studies on nurse prescribing of ionising radiation in other contexts have found it to be broadly as safe as ionising radiation prescribing by physicians. Sociological literature on perceptions of safety indicates that these tend to be shaped by the ideological position of the professional rather than based on objective evidence. Objectives: To describe, compare and analyse perceptions of the safety of a nurse prescribing of ionising radiation initiative across three occupational groups: nursing, radiography and medicine. Design: A cross-sectional survey design. Settings: Participants were drawn from a range of clinical settings in Ireland. Participants: Respondents were 167 health professionals comprised of 49 nurses, 91 radiographers, and 27 physicians out of a total of 300 who were invited to participate. Non-probability sampling was employed and the survey was targeted specifically at health professionals with a specific interest in, or involvement with, the development of the nurse prescribing of ionising radiation initiative in Ireland. Methods: Comparisons of perspectives on the safety of nurse prescribing of ionising radiation across the three occupational groups captured by questionnaire were analysed using the Kruskal–Wallis H test. Pairwise post hoc tests were conducted using the Mann–Whitney U test. Results: While the majority of respondents from all three groups perceived nurse prescribing of ionising radiation to be safe, the extent to which this view was held varied. A higher proportion of nurses was found to display confidence in the safety of nurse prescribing of ionising radiation compared to physicians and radiographers with differences between nurses’ perceptions and those of the other two groups being statistically significant. Conclusion: That an occupational patterning emerged suggests that perceptions about safety and risk of nurse prescribing of ionising radiation are socially constructed according to the vantage point of the professional and may not reflect objective measures of safety. These findings need to be considered more broadly in the context of ideological barriers to expanding the role of nurses