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This study evaluated the injury prevention program, Skills for Preventing Injury in Youth (SPIY) for Year 9 students (aged 13–14 years). The aim of SPIY was to reduce adolescent injury by reducing engagement in risk-taking behaviors. A randomized controlled trial was conducted and data analyzed with 32 schools, N = 2,739 students at baseline. Students’ self-reported injury prior to the commencement of SPIY and at 6 and 12 months after the program concluded. For those with few protective factors at baseline, there was less increase in alcohol-related injuries and a decline in violence-related injuries for intervention compared with control students. Findings showed the SPIY program can be effective in reducing adolescent injury for those with few promotive factors.

Adolescent intentional and unintentional injury is commonly related to involvement in violence and transportation behaviors. While many risk and promotive factors have been identified, a cumulative assessment of such factors is less common, and this has rarely been undertaken with transportation behaviors. The study involved Australian adolescents from high schools with greater than 75% of students from low socioeconomic status (SES) backgrounds, aged 13 to 14 years ( n = 826). Findings showed the presence of risk factors increased the odds of engagement in unintentional and intentional injury-risk behavior and the presence of promotive factors decreased the odds, supporting a compensatory model of resiliency. An interaction term of cumulative risk by promotive factors was a significant predictor in logistic regression analyses suggesting a protective-factor model of resiliency also applies. The research has implications for resiliency theory in the field of transportation and adds to the research on the value of compensatory and protective-factor models of resiliency.

Adolescents value protecting friends from harm and report that they do intervene as bystanders in friends' risky and dangerous behavior. Moreover intervention can be effective in reducing such behaviors. The Protection-Risk Framework was used to explain bystander intervention. There were 962 students from 13 Australian high schools (mean age at time 1=13.44 years) surveyed in their 9th grade and again 1-year later when students were in 10th grade. We found that protective factors of self-efficacy, support, prosocial models, social control, and ease of opportunity related to greater intervening behavior after 12-months. Among those who reported that they had intervened in a 3-month period, a cumulative measure of protective factors was associated with their reports of intervening. Risk factors were non-significant predictors after accounting for earlier, time 1, bystander intervening behavior and demographic factors. The findings highlight potential mechanisms to promote adolescents' looking out for their friends and provide an assessment over time of bystander behavior. The theory-guided inquiry into such behavior provides a foundation on which to better develop our understanding of benefits to adolescent friendship in the injury field.

Background: Driving while intoxicated (DWI) is a significant public health issue. The likelihood someone will intervene to prevent DWI is affected by the characteristics of the individuals and the context of the potential driving scenario. Understanding such contexts may help tailor public health messages to promote intervening from those who are nearby to an intoxicated driver. Objective: This systematic review investigates the behavior of those close to an intoxicated driver and factors associated with increasing the likelihood they will intervene in situations where driving while impaired may be likely. The review of the literature is guided by an orienting framework, namely the classic social psychology theory of decision-making proposed by Latane and Darley. Results: Drawing upon this framework, the review examines the extent to which research has focused on factors which influence whether or not an individual identifies a need to intervene and identifies a seriously dangerous situation. In a...

Young people in detention are at greater risk of death and disability from injury sustained while not in custody. Injury prevention and mental health programs have been designed for this group but their theoretical basis is rarely discussed. The present study investigates whether the conceptual basis of the Theory of Planned Behavior (TPB) is relevant to youth in a detention center. Focus group and observational data were collected. A thematic analysis supported central theoretical constructs and emphasized “Subjective Norms.” The challenge of normative influences must be actively addressed in the design of health interventions for youth in detention.

Injury is a significant public health problem among youth. A primary cause of adolescent injury is risk-taking behavior, including alcohol use, interpersonal violence and road-related risks. A novel approach to prevention is building on friendships by encouraging adolescents to intervene into their friends’ risk taking. Fifty-one early adolescents (13-14 years) and 44 older adolescents (16-17 years) from two Australian schools participated in focus groups, aiming to explore stories of intervening. Findings showed preference for talking to friends; however, participants also spoke to adults, monitored friends’ behavior and planned ahead. Close friendships, perceived harm, and self-efficacy influenced the likelihood of intervening. These findings have implications for the design of risk and injury prevention programs, by suggesting strategies to promote adolescents’ communicative ability for risk reduction. The findings also highlight the language and dialogue of adolescents and suggest that methods for increasing intervening behavior should focus on building social connectedness and increasing self-efficacy.

Adolescent risk-taking behaviour has potentially serious injury consequences and school-based behaviour change programmes provide potential for reducing such harm. A well-designed programme is likely to be theory-based and ecologically valid; however, it is rare that the operationalisation process of theories is described. The aim of this paper is to outline how the theory of planned behaviour and cognitive behavioural therapy informed intervention design in a school setting. Teacher interviews provided insights into strategies that might be implemented within the curriculum and provided detail used to operationalise theory constructs. Benefits and challenges in applying both theories are described with examples from an injury prevention programme, Skills for Preventing Injury in Youth.

School connectedness has been shown to be an important protective factor in adolescent development, which is associated with reduced risk-taking behavior. Interventions to increase students’ connectedness to school commonly incorporate aspects of teacher training. To date, however, research on connectedness has largely been based on student survey data, with no reported research addressing teachers’ perceptions of students’ connectedness and its association with student behavior. This research attempted to address this gap in the literature through in-depth interviews with 14 school teachers and staff from two Australian high schools. Findings showed that teachers perceived students’ connectedness to be important in regard to reducing problem behavior, and discussed aspects of connectedness, including fairness and discipline, feeling valued, belonging and having teacher support, and being successfully engaged in school, as being particularly important. This research enables the development of school-based...

School connectedness has a significant impact on adolescent outcomes, including reducing risk-taking behavior. This paper critically examines the literature on school-based programs targeting increased connectedness for reductions in risk taking. Fourteen articles describing seven different school-based programs were reviewed. Programs drew on a range of theories to increase school connectedness, and evaluations conducted for the majority of programs demonstrated positive changes in school connectedness, risk behavior, or a combination of the two. Many of the reviewed programs involved widespread school system change, however, which is frequently a complex and time-consuming task. Future research is needed to examine the extent of intervention complexity required to result in change. This review also showed a lack of consistency in the definitions and measurement of connectedness as well as few mediation analyses testing assumptions of impact on risk-taking behavior through increases in school connectedness. Additionally, this review revealed very limited evaluation of the elements of multicomponent programs that are most effective in increasing school connectedness and reducing adolescent risk taking.

Motor vehicle crashes are a leading cause of death among young people. Fourteen percent of adolescents aged 13-14 report passenger-related injuries within three months. Intervention programs typically focus on young drivers and overlook passengers as potential protective influences. Graduated Driver Licensing restricts passenger numbers, and this study focuses on a complementary school-based intervention to increase passengers' personal- and peer-protective behavior. The aim of this research was to assess the impact of the curriculum-based injury prevention program, Skills for Preventing Injury in Youth (SPIY), on passenger-related risk-taking and injuries, and intentions to intervene in friends' risky road behavior. SPIY was implemented in Grade 8 Health classes and evaluated using survey and focus group data from 843 students across 10 Australian secondary schools. Intervention students reported less passenger-related risk-taking six months following the program. Their intention to protect friends from underage driving also increased. The results of this study show that a comprehensive, school-based program targeting individual and social changes can increase adolescent passenger safety.

There is a continued need to consider ways to prevent early adolescent engagement in a variety of harmful risk-taking behaviours for example, violence, road-related risks and alcohol use. The current prospective study examined adolescents’ reports of intervening to try and stop friends’ engagement in such behaviours among 207 early adolescents (mean age = 13.51 years, 50.1% females). Findings showed that intervening behaviour after three months was predicted by the confidence to intervene which in turn was predicted by student and teacher support although not parental support. The findings suggest that the benefits of positive relationship experiences might extend to the safety of early adolescent friendship groups particularly through the development of confidence to try and stop friends’ risky and dangerous behaviours. Findings from the study support the important role of the school in creating a culture of positive adolescent behaviour whereby young people take social responsibility.

The purpose of this study was to challenge the broadly based focus of injury prevention strategies towards concern with the needs of young adolescents who engage in multiple anti-social and delinquent behaviours. Five hundred and forty 13-14-year olds reported on injuries and truancy, violence, illegal road behaviours, drug, and alcohol use. Engagement in these behaviours was found to contribute to the likelihood of an injury. Those engaging in the most anti-social and delinquent behaviours were around five times more likely to report medically-treated injuries in the past three months. Their likelihood of future injury was 1.8 times more likely when they were followed up three months later. The engagement in multiple delinquent and illegal behaviours thus significantly increased the likelihood of injury and identifies a particularly vulnerable group. The findings also suggest that reaching these young people represents a key target for change strategies in injury prevention programs.

The current study sought to understand adolescent protective behaviour in friendship using a Theory of Planned Behaviour framework. In particular, the study sought to consider a young persons' direct and active intervention to inhibit their friends' risky behaviour or to assist them when the behaviour leads to injury. The role of attitudes regarding the consequences, norms and control about protective behaviour were examined both qualitatively through focus groups (n=50) and quantitatively through surveys from a sample of 540, Year 9 students (13–14 years old). There was some support for the theory with attitudes regarding the consequences of the behaviour and norms predicting intended protective behaviour. A path analysis was conducted with a subsample of 140 students which showed that intentions to be protective and perceived control to undertake protective behaviour directly predicted such behaviour after a 3-month interval. Attitudes towards the consequences and norms only indirectly predicted protect...

Adolescents experience many benefits from bicycling; however, there are also potentially significant injury consequences. One effective counter-measure for the prevention of adolescent bicycling injuries is to promote bicycle helmet wearing. An overview is provided of injury risks of bicycle riding with particular attention to the role of helmet wearing and associated countermeasures such as legislation and school and community approaches. The findings are presented of a study conducted in Australia that examined the effectiveness of a theory-based injury prevention program, Skills for Preventing Injury in Youth (SPIY) for ninth-grade students (age 13 to 14 years). The findings showed a significant, 20.2% decrease in cycling without a helmet among the intervention students (n = 360) and no change for the students in the comparison group (n = 363) after 6 months. In addition, it was found that failing to wear a helmet was significantly associated with engaging in other transport-related risks, being male, having friends who do not wear a helmet and are specific targets of change in the SPIY program, showing a negative attitude toward risk, failing to intervene in friends’ risk-taking, and having low knowledge of first aid. Overall, the SPIY program appeared to be an effective theory-based intervention to increase helmet wearing among early adolescents, a group not often targeted in school and community helmet-wearing programs.

Background There is growing research finding associations between adolescents' concussion and negative outcomes, including violence, rarely however are the experiences of community-based early adolescents considered. Methods This study examined associations between reports of concussion (Time-1) and reports of violence 1-year later (Time-2). Australian adolescents from 13 high-schools completed two identical surveys administered 12-months apart (n = 734 retained, initial mean age = 13.45). Results At the first survey, 91 students (13%) reported they had a concussion, and of these students, 40% reported seeing a doctor/attending hospital during the prior 3 months. Both self-reported experience of violent injury (from getting in a fight) and violent behaviour (getting in a fight) were predicted by reports of concussion in Year 9. This prediction held, when adding sex, Year 9 reports of violence, alcohol use, truancy and engagement in passenger and driving risk-taking to logistic regression models. Year 9 concussion was not predictive of later injury in other contexts, including transportation, falls or sports. Conclusion The study highlights the need to understand concussion among community-based early adolescents including consider associations with violence.

The current research explores the relationship between people and their cars within the framework of Altman's theory of human territoriality. It further develops the research of Sandqvist by examining the descriptions given by people with differing ownership and uses of their cars and exploring the congruence between these and the characteristics used to describe human territories. Thirteen focus groups were held with young drivers between the ages of 18 and 25 years, drivers over the age of 25 who are parents of pre-license age children, drivers over the age of 25 who do not regularly transport children, and drivers of work vehicles. Analyses of discussions revealed that drivers’ descriptions of the relationship with their car could be matched with Brown and Altman's descriptions of territory types. However, variations existed both between and within individuals as to the application of the labels ‘primary’, ‘secondary’ and ‘public’ territory to the car. Implications for the understanding of road user behaviour and the further development of theory on the car as a place or an object in terms of territoriality are discussed.

Adolescent drivers are overrepresented in distraction-related motor vehicle crashes. A number of potential reasons for such an elevated risk include driving inexperience, high adoption of communication technology, increased peer involvement, and tendency to take risks, which render young drivers particularly vulnerable. Major legislative efforts in Graduated Licensing Systems that include passenger restrictions have shown positive effects. Restrictions on cell phone use are also being introduced; however, it is challenging to enforce such regulations. This article argues that such contextual, legislative interventions are an essential prevention strategy, but there is an unfilled need to introduce behavior change programs that may target adolescents, parents, and friends. A theoretical framework is applied in which risk and protective factors are identified from research within the contexts of community and jurisdiction. In the literature on distraction, social context and normative influences are key elements used to inform program design for adolescent drivers, with parental monitoring informing interventions targeting parents. Following from this assessment of the message content assessment, the design of strategies to deliver the messages is reviewed. In the current literature, school-based programs, simulations, and Web-delivered programs have been evaluated with supplementary strategies delivered by physicians and parents. Such developments are still at an early stage of development, and ultimately will need controlled implementation and evaluation studies. Of course, there is no likely single approach to prevent adolescent driver distraction. Complementary approaches such as the further development of technological interventions to manage phone use are needed.

School connectedness is an important protective factor for adolescent risk-taking behaviour. This study examined a pilot version of the Skills for Preventing Injury in Youth (SPIY) programme, combining teacher professional development (PD) for increasing school connectedness (connectedness component) with a risk and injury prevention curriculum for early adolescents (curriculum component). A process evaluation was conducted on the connectedness component, involving assessments of programme reach, participant receptiveness and initial use, and a preliminary impact evaluation was conducted on the combined connectedness and curriculum programme. The connectedness component was well received by teacher participants, who saw benefits for both themselves and their students. Classroom observation also showed that teachers who received PD made use of the programme strategies. Grade 8 students who participated in the SPIY programme were less likely to report violent behaviour at 6-month follow-up than were control students, and trends also suggested reduced transport injuries. The results of this research support the use of the combined SPIY connectedness and curriculum components in a large-scale effectiveness trial to assess the impact of the programme on students' connectedness, risk-taking and associated injuries.

Adolescents engage in many risk-taking behaviors that have the potential to lead to injury. The school environment has a significant role in shaping adolescent behavior, and this study aimed to provide additional information about the benefits associated with connectedness to school. Early adolescents aged 13 to 15 years (N=509, 49% boys) were surveyed about school connectedness, engagement in transport and violence risk-taking, and injury experiences. Significant relations were found between school connectedness and reduced engagement in both transport and violence risk-taking, as well as fewer associated injuries. This study has implications for the area of risk-taking and injury prevention, as it suggests the potential for reducing adolescents' injury through school based interventions targeting school connectedness.

Background Adolescent injury is a serious public health concern. Adolescents classified as high-risk are a population most vulnerable to harm from injury due to increased engagement in risk-taking behaviour. Aims/Objectives/Purpose The aim of this research is to evaluate responsiveness of high-risk young Australian adolescents (13-14 years) to a curriculum based injury prevention programme. Methods Fifteen schools implemented the Skills for Preventing Injury in Youth (SPIY) programme in April to June 2012. Focus groups were conducted with a random sample of teachers after the conclusion of SPIY in July 2012.Teachers classified the risk-level of students based on perceptions of student engagement in risk-taking behaviour (eg, alcohol, violence, transport risks) and reported on dose, adherence, quality of process and participant responsiveness. Results/Outcomes The findings of teacher focus groups are presented regarding perceptions of the implementation of the curriculum based injury prevention programme and perceived responsiveness for high-risk young adolescents. Programme strengths and weaknesses are reported in the context of meeting the needs of high-risk young adolescents and the amount of material high-risk young adolescents received in line with the SPIY curriculum. Significance/Contribution to the Field Teachers provide insight into responsiveness of high-risk young adolescents for a curriculum based injury prevention programme as well as the way it is implemented for high-risk young adolescents. Findings of this research have the potential to enhance implementation of school based interventions for high-risk young adolescents who are still participating in mainstream schooling and maximise programme effect and sustainability. This is an abstract of a presentation at Safety 2012, the 11th World Conference on Injury Prevention and Safety Promotion, 1-4 October 2012, Michael Fowler Center, Wellington, New Zealand. Full text does not seem to be available for this abstract.

Background Injury is a leading cause of adolescent death. Risk-taking behaviours, including unsafe road behaviours, violence and alcohol use, are primary contributors. Recent research suggests adolescents look out for their friends and engage in protective behaviour to reduce others' involvement in risk-taking. A positive school environment, and particularly students' school connectedness, is also associated with reduced injury-risks. Aim This study aimed to understand the role of school connectedness in adolescents' intentions to protect and prevent their friends from involvement in alcohol use, fights, drink driving and unlicensed driving. Method Surveys were completed by 540 13-14-year-old students (49% male). Four sequential logistic regression analyses were conducted to determine whether school connectedness statistically predicted intentions to protect friends from injury-risk behaviours. Gender and ethnicity were entered at step 1, students' own risk behaviour at step 2, and school connectedness scores at step 3 for all analyses. Results School connectedness significantly predicted intentions to protect friends from all four injury-risk behaviours, after accounting for the variance attributable to sex, ethnicity and adolescents' own involvement in injury-risks. Significance School connectedness is negatively associated with adolescents' own injury-risk behaviours. This research extends our knowledge of this critical protective factor, as it shows that students who are connected to school are also more likely to protect their friends from alcohol use, violence and unsafe road behaviours. School connectedness may therefore be an important factor to target in school-based prevention programmes, both to reduce adolescents' own injury-risk behaviour and to increase injury prevention among friends. This is an abstract of a presentation at Safety 2012, the 11th World Conference on Injury Prevention and Safety Promotion, 1-4 October 2012, Michael Fowler Center, Wellington, New Zealand. Full text does not seem to be available for this abstract.

A process evaluation enables understanding of critical issues that can inform the improved, ongoing implementation of an intervention programme. This study describes the process evaluation of a comprehensive, multi-level injury prevention programme for adolescents. The programme targets change in injury associated with violence, transport and alcohol risks and incorporates two primary elements: an 8-week, teacher delivered attitude and behaviour change curriculum for Grade 8 students; and a professional development programme for teachers on school level methods of protection, focusing on strategies to increase students9 connectedness to school. A comprehensive process evaluation methodology was used, including assessments of dose, adherence, quality of process and participant responsiveness with teachers and Grade 8 students at four Australian high schools. Programme dose, adherence and quality of curriculum delivery were assessed through independent observations. The observer also rated the degree to which teachers used connectedness strategies in class, following participation in professional development. Teachers9 responsiveness to the professional development element was assessed through surveys immediately following the training, and through focus groups for in-depth information. Student focus groups also enabled insight into their responsiveness to the programme and their perceptions of teachers9 use of connectedness strategies. The results of this research provide an understanding of the application of a process evaluation to a comprehensive injury prevention programme and enable insight into the means by which the programme may be better implemented to maximise effect and sustainability. The findings also provide insight into the potential value of school connectedness in adolescent injury prevention.