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