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

Thomas, J and Kavanagh, J and Tucker, H and Burchett, H and Tripney, J and Oakley, A (2007) Accidental injury, risk-taking behaviour and the social circumstances in which young people (aged 12-24) live: a systematic review. London: EPPI-Centre, Social Science Research Unit, Institute of Education, University of London.

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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 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.

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