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The Risk Taking Years. CYMRC - To identify, address and potentially decrease the numbers of infant, child and youth deaths in New Zealand Nick Baker. CYMRC Process – Deaths 28 days to 25 th Birthday. Database. Analysis. Literature. LCYMRG. DHB. Child or Youth Death. - PowerPoint PPT Presentation
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The Risk Taking Years
CYMRC - To identify, address and potentially decrease the numbers of infant, child and youth deaths in New Zealand
Nick Baker
Child orYouth Death
Database
Policy, Strategy, Systems Change
Analysis Literature
Media
Strategic Partners
Ministries
Public Opinion
Ministers
DHBLCYMRG
CYMRC Process – Deaths 28 days to 25th Birthday
CYMRCRecommendations
HQSC
Health Minister
N = 5391
NZ Mortality by Age Group 1979 - 2010
0
50
100
150
200
250
Deaths by Residence and Age group
4-52 weeks
1-4 years
5-9 years
10-14 years
15-19 years
20-24 years
Ref - Table J1 CYMRC Fifth Report
Unintentional death rate, by age and gender 2003–2007
About 140 Transport Deaths per year 14-2514% of the population having 33% of transport deaths
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
Cause of mortality in youth aged 15–24 years (%), by category of death, 2003–2008 combined (2366 deaths)
Unintentional injury mortality, by age group and injury type
2003–2007 (rate per 100,000)
[R.P.1]
Northland
Wait
emata
Auckland
Counties M
anukau
Waik
ato
Bay of P
lenty
Lakes
Tairawhiti
Taranak
i
Hawke's B
ay
Whan
ganui
MidCen
tral
Waira
rapa
Capital &
Coast
Hutt Valle
y
Nelson M
arlboro
ugh
West
Coast
Canterbury
South Canter
buryOtago
Southland0
10
20
30
40
50
60
DHB of death
Mor
talit
y ra
te p
er 1
00,0
00
Youth (15-24 years) transport mortality rates per 100,000, by DHB of death,
2003–2007
South Island Land Transport Injury Admissions 2006-10
DHBNumber:
Total per 5 Year Period
Number: Annual Average
Rate per 100,000 Rate Ratio 95% CI
Land Transport InjuriesHospital Admissions in Young People Aged 15–24 Years, 2006–2010
Nelson Marlborough 442 88.4 561.2 1.54 1.40–1.70
West Coast 171 34.2 935.2 2.57 2.21–2.99Canterbury 1,114 222.8 305.4 0.84 0.79–0.89South Canterbury 211 42.2 671.3 1.85 1.61–2.11Otago 553 110.6 325.5 0.89 0.82–0.97Southland 407 81.4 559.5 1.54 1.39–1.70New Zealand 11,519 2,303.8 363.8 1.00
Drowning in New Zealand, 2003–2007 by Year of Age
1 1
4
7
42 2
42
42
11
1 1
411
1
11
51
11
2
2
1
1 1
23 3
1
11
1
2
3
43
1
1
1
1
1
1
2
11
1
21
1
1
1
1
0
2
4
6
8
10
12
14
16
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
All othersRecreational drugsPsychiatric medicinesMethadoneMorphine and codeineAlcoholOther gases and volatile liquidsButane, LPG and other hydrocarbons
Number of deaths
Age in yearsSource: CYMRC Data Collection; Numerator Sbstance Group determined following case review of CYMRC data
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)
Teens burnt in explosion allegedly sniffing gas
Influencing policy and legislation· Control legal access to substances and require warning labels
Mobilizing neighborhoods and communities· Recognise abusers reduce sales and access
Changing organizational practices· Voluntary control by retailers· Warning labels on products· Offensive odours, tastes, colouring - research needed· Use alternate products and safer storage systems
Spectrum of Prevention
Spectrum of Prevention
Fostering coalitions and networks· Lead agency nominated with the development of coalitions
Educating providers· Screen & support young people after risk taking related harm
Promoting community education· School based, retailers, parents, caregivers
Strengthening individual knowledge and skills· Strategies to build risk competence· Connecting young people to supports
Assuring access to quality health care· Identify users and connect to health services
All injury (intentional/unintentional)Number of visits to Nelson Emergency Department by age at time of visit
2004-2009
0
500
1000
1500
2000
2500
1 5 9 13 17 21 25 29 33 37 41 45 49 53 57 61 65 69 73 77 81 85 89 93 97 101 105
Age
Cou
nt
Acknowledgment Bronwyn White Injury Prevention Health Promoter - NMDHB PHU
Quite common for young people to suffer a number of injuries before death
– “frequent flyers”
0
10
20
30
40
50
60
70
80
90
100
Age(in years)
Coun
tNumber of visits to ED as a result of a motorvehicle incident by age
Acknowledgment Bronwyn White Injury Prevention Health Promoter - NMDHB PHU
1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67 70 73 76 79 82 850
2,000,000
4,000,000
6,000,000
8,000,000
10,000,000
12,000,000
14,000,000
16,000,000
18,000,000
Cost of Serious Injury by Year of Age When Claim First Registered 2009C
ost
Thanks to ACC Lorna Blunt AGE in Years
NZ intentional
NZ unintentional
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)
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
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
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
Safe
Dangerous
Timid
RecklessWise
RiskAvoider
RiskSeekerherocoward
Out-going
Pioneer Adventurer
Plucky Brave Bold
Daring Fearless
Courageous Impulsive
Overconfident Impudent
Irresponsible Foolhardy
Faint-hearted Fearful
Diffident Hesitant Nervous Anxious
Apprehensive Careful
Circumspect Far-sighted
Wary Prudent Sensible
“A true hero knows when to be a coward!”
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
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
Through the Eyes of a Child?
NZ Injury Deaths 2005-07 n=357
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
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”
Kaikohe unicyclists aim for the top
Exceptional Efforts from Exceptional PeopleHow do we make it easier?
Risk Competence Lower• Novice• Peer presence• Males• Disconnected• Alcohol • Drugs• Aimless• Mental illness• ADHD• Disability
Greater• Experience – transferability• Practiced decision maker• Perception of Risk• Values and Attitudes• Sense of control• Mentoring• Supervision• Connections• Purpose• Learn from Mistakes
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
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
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
- cf SafeKids• Developmental preventive interventions • Need a common national approach
– Lead agency injury prevention 14-24 or 0-19?
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
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