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Behind the coronavirus headlines the year 2020 set multiple extreme weather records, including unprecedented wildfires in Australia and California, massive flooding in China, and back-to-back hurricanes in Central America. The impacts on the well-being of local populations have been devastating. We reviewed these extreme weather events, together with the year’s newly published climate and health science reports, and identified three important themes for building health resilience in the decade ahead: (1) preparing for greater magnitude and intensity of climate hazards, extreme events, and population health impacts; (2) better anticipating cascading and compound impacts on population well-being, particularly for the most vulnerable; and (3) identifying appropriate, effective preparedness tools and strategies. While decarbonizing the economy is the urgent goal to protect both human and planetary health from a changing climate, 2020 demonstrates that recognizing the likely magnitude and complexity of future extreme weather events, and preparing local public health agencies and communities with the knowledge and tools to respond to them, will be essential in this critical decade.

The early 2020 response to COVID-19 revealed major gaps in public health systems around the world as many were overwhelmed by a quickly-spreading new coronavirus. While the critical task at hand is turning the tide on COVID-19, this pandemic serves as a clarion call to governments and citizens alike to ensure public health systems are better prepared to meet the emergencies of the future, many of which will be climate-related. Learning from the successes as well as the failures of the pandemic response provides some guidance. We apply several recommendations of a recent World Health Organization Policy Brief on COVID-19 response to 5 key areas of public health systems – governance, information, services, determinants, and capacity – to suggest early lessons from the coronavirus pandemic for climate change preparedness. COVID-19 has demonstrated how essential public health is to well-functioning human societies and how high the economic cost of an unprepared health system can be. This pandemic provides valuable early warnings, with lessons for building public health resilience.

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.

Extreme weather events (EWEs) affected health in every world region during 2021, placing the planet in “uncharted territory.” Portraying the human impacts of EWEs is part of a health frame that suggests public knowledge of these risks will spur support for needed policy change. The health frame has gained traction since the Paris COP21 (United Nations Climate Change Conference) and arguably helped to achieve modest progress at the Glasgow COP26. However, reporting rarely covers the full picture of health impacts from EWEs, instead focusing on cost of damages, mortality, and displacement. This review summarizes data for 30 major EWEs of 2021 and, based on the epidemiological literature, discusses morbidity-related exposures for four hazards that marked the year: wildfire smoke; extreme cold and power outages; extreme, precipitation-related flooding; and drought. A very large likely burden of morbidity was found, with particularly widespread exposure to risk of respiratory outcomes (including interactions with COVID-19) and mental illnesses. There is need for a well-disseminated global annual report on EWE morbidity, including affected population estimates and evolving science. In this way, the public health frame may be harnessed to bolster evidence for the broader and promising frame of “urgency and agency” for climate change action.

Introduction : In mid-2007 the State of New South Wales (NSW) in Australia introduced modifications to the existing graduated driver licensing system, lengthening the mandatory number of supervised hours for learner drivers aged under 25 years from 50 to 120 and extending the minimum learner period from 6 to 12 months. Additional driving restrictions were also introduced for young drivers in the two provisional licensed periods, P1, P2. This paper aims to evaluate this change by comparing the crash and offense experiences of young learner drivers before and after it occurred. Method : From driver licensing files supplied by the NSW transport authority two cohorts of persons obtaining their initial learner's permits in the year prior to the changes and in the subsequent year were constructed with demographic data, dates of transition to the driving phases, dates of crashes, and dates and types of traffic offenses. Both cohorts comprised around 100,000 individuals. Crash rates per 100 years of person-time under observation post P1 with their standard errors were calculated. Using a survival-analytic approach the proportion of crashes of all types were graphed in three month periods post P1. Sexes were treated separately as were initial learner ages of 16, 17, 18–21, and 22–24 years. The distribution of traffic offense types during P1 and P2 phases were also compared. With such large numbers formal statistical testing was avoided. Results : No meaningful differences in the crash or offense experiences of the two cohorts in either sex or at any age were observed. Delaying progress to unsupervised driving has road safety benefits. Conclusions : At least in conditions similar to those in NSW, requiring more than 50 h of supervised driving seems to have few road safety benefits. Practical applications : Licensing authorities should be cautious in extending the mandated number of supervised driving hours beyond 50.

Climate change has important population health impacts, and cities are often on the frontlines. However, health is reported to be less active in climate adaptation than other sectors. To contribute to better understanding urban health adaptation efforts and identifying gaps we developed a City Climate Health Adaptation Typology and tested it with adaptation actions of 106 large world cities (population > 1 million) reported to a major publicly-available adaptation database. We found two-thirds of actions of these 'active adapter' cities were health-associated. Half were health information activities (e.g., hazard mapping, early warnings); and nearly one-third addressed climate-relevant health determinants in the urban built environment (e.g., green space). Forty percent of cities were in low- or middle-income countries. Our proposed typology provides a systematic framework for monitoring and comparing city health adaptation actions. Reported city actions are suggestive of increasing depth and breadth of urban health-associated adaptation. However, even among these adaptation-engaged cities, a health adaptation gap was apparent in key climate health services (e.g., mental health), and in climate-related public health governance and capacity building. The COVID-19 pandemic has demonstrated pressing need for strong public health institutions. We recommend better integration of public health agencies into local climate action planning, enhanced modes of collaboration between health and non-health agencies and with non-governmental actors, and strengthening of city public health adaptive capacity including through networking.

Over the last decade many large world cities have scaled up efforts at climate adaptation, a primary focus of which is protecting population health. With extreme weather disasters increasing worldwide, public health agencies are among local institutions under greatest stress; the Covid-19 pandemic has only heightened pressure on these agencies. Yet the limited literature examining adaptation actions across world cities suggest few, mainly high-income cities report health-related adaptation, while city public health agency engagement in adaptation has received little research attention. In this comparative review, we aimed to characterize the public health role in the adaptation plans of 22 large cities pre-identified as highly health-adaptive, by examining five health-associated adaptation activities chosen as “promising practice” based on evidence synthesized from evaluation research and practical experience: (i) hazard and vulnerability mapping; (ii) extreme weather preparedness and response; (iii) extreme heat plans (including heat early warning); (iv) non-heat early warning (e.g., flooding, vector-borne disease); and (v) climate-health monitoring and outcome surveillance. We found most (90%) city adaptation plans reported actions in at least three of these five activity areas. However, only 73% of these health-focused plans reported involvement of a public health agency (though the share was higher for cities in low- and middle-income countries). We detected differences across the five activities, including an ascending pattern of public health engagement starting with heat plans and including activities such as preparedness and mapping as health agency involvement increased. We also identified substantial presence of other city agencies–notably urban planning, emergency management and public utilities–in implementing these health-associated activities. With every world region likely to experience more widespread and intensifying climate impacts, and growing pressure on local public health agencies in conjunction with the Covid-19 pandemic, we identify opportunities for enhancing public health engagement in climate adaptation in large cities with a view to scaling up their ability to contribute to climate adaptation goals.

Road trauma is a significant health problem in rural and remote regions of Australia, particularly for Indigenous communities. This study aims to identify and compare the circumstances leading to (proximal causation) and social determinants of (distal causation) crashes of Indigenous and non-Indigenous people in these regions and their relation to remoteness. This is a topic seriously under-researched in Australia. Modelled on an earlier study, 229 persons injured in crashes were recruited from local health facilities in rural and remote North Queensland and interviewed, mainly by telephone, according to a fixed protocol which included a detailed narrative of the circumstances of the crash. A qualitative analysis of these narratives identified several core themes, further explored statistically in this sample, supplemented by participants in the earlier study with compatible questionnaire data, designed to determine which factors were more closely associated with Indigenous status and which with remoteness. Indigenous participants were less often vehicle controllers, more likely to have recently been a drink driver or passenger thereof, to be unemployed, unlicensed, distracted or fatigued before the crash, alcohol dependent and have lower perceived social, but not personal, locus of control in a traffic crash than non-Indigenous persons. Differences between Indigenous and non-Indigenous participants are largely ascribable to hardship and transport disadvantage due to lack of access to licensing and associated limitations on employment opportunities. Based on these findings, a number of policy recommendations relating to educational, enforcement and engineering issues have been made.

Introduction: School-based first aid training has benefits for adolescents with an opportunity to increase health and safety knowledge relating to injury and cardiac arrest. Method: Using a quasi-experimental design we evaluated differences among students (Mage = 13.46 years, 55% female) taught first aid through the Skills for Preventing Injury in Youth (SPIY) program (n = 1942), treatment-as-usual school-based first aid training (n = 675), and students who did not receive first aid training (n = 489). Results: Results showed significant differences in self-reported knowledge scores at twelve-month follow-up (controlling for baseline knowledge). Students in the SPIY group and the treatment-as-usual first aid group had higher total scores than the control group. Teachers and students reported positive perceptions to first aid study, in particular the interactive delivery and scenarios for contextualizing information. Practical Applications: The study provides support for the retention of first aid knowledge up to 12-months and thus the inclusion and feasibility of first aid training in secondary school curriculum.

Objective Drunk driving (blood alcohol concentration (BAC) 80 mg/100 ml) was upgraded to become a criminal offence under China's Criminal Law in May 2011. While this had a major road safety benefit, there was still a high level of alcohol related crashes and fatalities. This paper develops recommendations based on a programme of research undertaken in 2012 that examined the perceptions of general motor vehicle drivers, convicted drunk driving offenders and traffic police about drinking and driving and law enforcement in the cities of Guangzhou and Yinchuan. Alcohol misuse problems were also explored using the Alcohol Use Disorders Identification Test (AUDIT). This paper integrates the findings to examine existing problems in alcohol management, law enforcement, education and rehabilitation and provides recommendations for addressing alcohol-related driving in China. Methods A multi-study cross-sectional research programme was conducted in two Chinese cities involving general drivers, drunk driving offenders and traffic police. In total, 16 traffic police officers were interviewed and 105 traffic police officers were surveyed. In addition, 207 drunk driving offenders in detention facilities and 802 general motor vehicle drivers were surveyed. Results Traffic police resources including human resources and facilities such as breathalysers were reported as insufficient in both cities. There were problems reported in the process of law enforcement, and shortcomings in police knowledge of factors involved in drink/drunk driving and in the practice of conducting breath alcohol testing (BAT). Knowledge about legal BAC levels and how to keep under the legal limit was very low among general motor vehicle drivers and drunk driving offenders. Proportions with alcohol misuse problems in the two driver groups were high, especially among offenders. Conclusions Recommendations to manage alcohol-related driving are proposed for the three groups of traffic police, general motor vehicle drivers and drunk driving offenders. In particular, traffic police resources need to be improved and further education provided to police on the general deterrence potential of BAT. There should be enhanced community education and publicity to improve knowledge of drink driving regulations and how to avoid breaking the law. Alcohol misuse problems should be addressed, particularly for drunk driving offenders.

Background: Systematic review and meta-analysis (SRMA) are increasingly employed in environmental health (EH) epidemiology and, provided methods and reporting are sound, contribute to translating science evidence to policy. Ambient air pollution (AAP) is both among the leading environmental causes of mortality and morbidity worldwide, and of growing policy relevance due to health co-benefits associated with greenhouse gas emissions reductions. Objectives: We reviewed the published AAP SRMA literature (2009 to mid-2015), and evaluated the consistency of methods, reporting and evidence evaluation using a 22-point questionnaire developed from available best-practice consensus guidelines and emerging recommendations for EH. Our goal was to contribute to enhancing the utility of AAP SRMAs to EH policy. Results and discussion: We identified 43 studies that used both SR and MA techniques to examine associations between the AAPs PM2.5, PM10, NO2, SO2, CO and O3, and various health outcomes. On average AAP SRMAs partially or thoroughly addressed 16 of 22 questions (range 10–21), and thoroughly addressed 13 of 22 (range 5–19). We found evidence of an improving trend over the period. However, we observed some weaknesses, particularly infrequent formal reviews of underlying study quality and risk-of-bias that correlated with lower frequency of thorough evaluation for key study quality parameters. Several other areas for enhanced reporting are highlighted. Conclusions: The AAP SRMA literature, in particular more recent studies, indicate broad concordance with current and emerging best practice guidance. Development of an EH-specific SRMA consensus statement including a risk-of-bias evaluation tool, would be a contribution to enhanced reliability and robustness as well as policy utility. Keywords: Systematic review, Guidelines, Meta analysis, Environmental health, Air pollution, Climate change

Objective This study was conducted after a legislative amendment criminalising drunk driving (BAC > 80 mg/100 ml) had been in force for a year and investigated whether drunk driving offenders in Yinchuan, China were aware of the law, and whether their knowledge of and exposure to enforcement and the existence of alcohol use disorders were related to their alcohol-involved driving behaviour. The results were compared with results from an earlier study in Guangzhou, China. Method A survey was conducted from July to October 2012 in Yinchuan to collect information on drunk driving offenders’ knowledge and practice in relation to alcohol-involved driving. The Alcohol Use Disorders Identification Test (AUDIT) was used to assess hazardous drinking levels. In total, 106 drunk driving offenders were recruited while in detention. The findings were compared with those of the Guangzhou study, where the same procedure was used to recruit 101 drunk driving offenders. Results The mean age of the sample was 31.7 years (SD = 8.1; range 17–59 years). Males constituted 96% of the sample. The mean age at which offenders reported starting to drink alcohol was 18.7 years (SD = 3.2; range 10–26 years). Driver’s licenses had been held for an average of 8.5 years. The status of knowledge in relation to alcohol-involved driving in Yinchuan was slightly lower in proportion than in Guangzhou. The rate of alcohol-involved driving reported in the previous 12 months in Yinchuan (43%) was slightly higher than in Guangzhou (39%). The proportion of recidivists in Guangzhou (21.8%) was higher than Yinchuan’s (10.4%). On average, offenders had experienced 1.6 police alcohol breath tests in the previous year (SD = 1.3; range 1–10). AUDIT scores indicated that a substantial proportion of the offenders had high levels of alcohol use disorders. Discussion Limited awareness of legal alcohol limits might contribute to drunk driving offences. The high level of alcohol consumption by many offenders suggests that hazardous drinking levels may be a contributor. Recidivist drivers also had higher AUDIT scores, which suggest there may be benefit in using the AUDIT to identify potential drink drivers and recidivists, subject to further research.

Objective: This study examines the constructs from the health action process approach (HAPA) theoretical model (Schwarzer, 1992) on future drink driving avoidance by first time drink driving offenders. This research presents an advance in health related theory by the novel application of the health model to predict risk avoidance. Method: Baseline interviews were conducted with 198 first time drink driving offenders at the time of court appearance, and offenders were followed up 6–8 months following the offense date. The key outcome variables used in 3 stages were behavioral expectation, planning, and self-reported avoidance of drink driving at follow-up. Results: Bivariate and multivariate analyses were conducted for each stage. High task self-efficacy and female gender were significantly related to having no behavioral expectation of future drink driving. High maintenance self-efficacy was significantly related to high levels of planning to avoid future drink driving. Those with higher planning scores at baseline had significantly higher odds of reporting that they had avoided drink driving at follow up. Conclusion: Planning plays an important role in drink driving rehabilitation and should be a focus of early intervention programs aimed at reducing drink driving recidivism following a first offense. Self-efficacy is an important construct to consider for the behavior and could strengthen a planning focused intervention. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Extreme weather events such as heat waves, extreme precipitation, and storm surges are likely to become more frequent and intense with climate change. Extreme weather-driven disasters (EWDDs) cause a substantial burden of childhood mortality and morbidity worldwide. We reviewed the published literature on EWDDs and their health impacts on children, and developed a conceptual model based on complex systems thinking to identify the health risks, vulnerabilities, and capacities of children in the context of EWDDs as a means of informing areas for adaptive intervention. We found that direct and indirect physical and mental impacts of EWDDs on child health are abundant and interrelate in complex ways. The literature review and modeling demonstrated the centrality of resilience at the level of the child and his or her direct environment, suggesting that mental health status may play a key role in a child’s experience of numerous other health outcomes of EWDDs. EWDDs interact with environmental and social systems and with individual children and their contexts in complex ways, the impacts of which are nonlinear and difficult to predict. Traditional perspectives on climate change-driven health impacts often overlook complex bio-psychosocial interactions, suggesting a need to work on preventive strategies to reduce vulnerability and build individual child resilience.

Jia, K., Fleiter, J., King, M., Sheehan, M., Ma, W., & Zhang, J. (2015). Knowledge and behaviors of drunk-driving offenders in Guangzhou, China. The International Journal Of Alcohol And Drug Research, 4 (2), 151-158. doi: http://dx.doi.org/10.7895/ijadr.v4i2.203 Aims: To better understand the knowledge and behaviors of drunk-driving offenders relating to alcohol use and driving in the context of recently amended Chinese legislation, and to investigate the involvement of alcohol-use disorders. Design: The study was a cross-sectional survey conducted in 2012. Setting and participants: Data were collected at a local jail and 101 participants were recruited while in detention. Measures: Questionnaire items examined demographic characteristics as well as practices and knowledge relating to alcohol use and driving. The Alcohol Use Disorders Identification Test (AUDIT) was used to assess hazardous drinking levels. Findings: Knowledge about the two legal limits for “drink driving” and for “drunk driving” was low, at 28.3% and 41.4%, respectively. AUDIT scores indicated that a substantial proportion of the offenders had high levels of alcohol-use disorders. Higher AUDIT scores were found among the least experienced drivers, those who lacked knowledge about the legal limits, and recidivist drunk drivers. Conclusions: Limited awareness of legal alcohol limits might contribute to offending; high AUDIT scores suggest that hazardous drinking levels may also contribute. This study provides important information to assist in refining community education and prevention efforts.

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.

Summary: Public health has potential to serve as a frame to convey the urgency of behavior change needed to adapt to a changing climate and reduce greenhouse gas emissions. Local governments form the backbone of climate-related public health preparedness. Yet local health agencies are often inadequately prepared and poorly integrated into climate change assessments and plans. We reviewed the climate health profiles of 16 states and two cities participating in the U.S. Centers for Disease Control and Prevention (CDC)’s Climate-Ready States and Cities Initiative (CRSCI) that aims to build local capacity to assess and respond to the health impacts of climate change. Following recommendations from a recent expert panel strategic review, we present illustrations of emerging promising practice and future directions. We found that CRSCI has strengthened climate preparedness and response in local public health agencies by identifying critical climate-health impacts and vulnerable populations, and has helped integrate health more fully into broader climate planning. Promising practice was found in all three recommendation areas identified by the expert panel (leveraging partnerships, refining assessment methodologies and enhancing communications), particularly with regard to health impacts of extreme heat. Vast needs remain, however, suggesting the need to disseminate CRSCI experience to non-grantees. In conclusion, the CRSCI program approach and selected activities illustrate a way forward toward robust, targeted local preparedness and response that may serve as a useful example for public health departments in the United States and internationally, particularly at a time of uncertain commitment to climate change agreements at the national level. https://doi.org/10.1289/EHP1838

Purpose: Digital interventions to reduce risk behaviours are emerging as effective public health measures; however, few have been applied to drink driving and associated alcohol use based on a harm reduction perspective. This paper reports on the design, development, and pilot of a novel intervention which aims to reduce repeat offending by first time convicted drink driving offenders. It explores whether an online program is acceptable and user friendly, and contains useful and relevant content, with a sample of first time drink driving offenders recruited at the time of conviction. Methods: Building upon existing research into interventions to reduce drink driving recidivism and problem alcohol use, a tailored program was designed to provide content specifically concerned with drink driving and with an additional component related to alcohol use. Following stakeholder and internal review, the ‘Steering Clear First Offender Drink Driving Program’ was subsequently piloted with 15 first time drink driving offenders. Evaluative data was analysed both quantitatively and qualitatively. Results: The pilot results indicate that the participants found the program to be user friendly, as demonstrated by high scores in relation to navigation, online delivery, engagement, avatar usage, and straightforwardness. They reported that they found the content to be useful and relevant and that the key learning area was in relation to the consequences of drink driving. Conclusions: Online interventions for reducing risky behaviour such as drink driving may be useful and cost effective from a public health perspective. Potentially, they can directly address risky behaviours associated with alcohol use in high risk cohorts that may not ordinarily receive intervention.

The lack of definitional consistency about domestic violence and the absence of a well-validated comprehensive abuse screening questionnaire have been major methodological flaws in domestic violence research. While there are several screening questionnaires in use, they either are narrowly defined and do not have discrete measures of physical, emotional, and sexual abuse or have not been validated on both abused and nonabused samples. This study presents the development and preliminary validation of a new partner abuse screening questionnaire (Composite Abuse Scale; CAS). Items measuring the three areas of partner abuse were extracted from four published scales: the Conflict Tactics Scale, Measure of Wife Abuse, Inventory of Spouse Abuse, and Psychological Maltreatment of Women Inventory. A survey using these items was sent to all nurses working at a large Australian public, inner-city teaching hospital. Factor analyses of the responses of 427 participants revealed four dimensions: Severe Combined Abuse, Emotional Abuse, Physical Abuse, and Harassment. Preliminary evidence is presented on validity and a high scale reliability is reported fof each subscale.

The future on-road safety of drivers affected by Whiplash Associated Disorder (WAD), the most common soft-tissue injury suffered in a traffic crash, has not been extensively explored. We obtained an anonymised file of 4280 insurance claimants with WAD and, as controls, 1116 claimants with comparably severe soft-tissue injuries who are considered to be at no increased risk than the general population. Their demographic information, road user type and traffic crash records both prior and subsequent to the traffic incident in which the injury occurred, the index crash, were obtained. Rates of subsequent crash involvement in these two groups were then compared, adjusting for age, sex, road user type and prior crash experience. The risk of a subsequent crash in the WAD group relative to controls was 1.14 (95% confidence interval, 0.87–1.48). To allow for differentially altered driving exposure after index crash we distributed a brief survey asking about changes in driving habits after a traffic crash involving injury via physiotherapy clinics and online through the electronic newsletter of a local motoring organisation. The survey yielded responses from 113 drivers who had experienced WAD in a traffic crash and 53 with other soft tissue injuries. There were no differences on average between the groups in their prior driving levels or their percentage change therein at one, three or six months after injury. There was thus no evidence that drivers with WAD are at any higher safety risk than drivers with other types of relatively minor post-crash soft tissue injury.

Policy action in the coming decade will be crucial to achieving globally agreed upon goals to decarbonize the economy and build resilience to a warmer, more extreme climate. Public health has an essential role in climate planning and action: “Co-benefits” to health help underpin greenhouse gas reduction strategies, while safeguarding health—particularly of the most vulnerable—is a frontline local adaptation goal. Using the structure of the core functions and essential services (CFES), we reviewed the literature documenting the evolution of public health’s role in climate change action since the 2009 launch of the US CDC Climate and Health Program. We found that the public health response to climate change has been promising in the area of assessment (monitoring climate hazards, diagnosing health status, assessing vulnerability); mixed in the area of policy development (mobilizing partnerships, mitigation and adaptation activities); and relatively weak in assurance (communication, workforce development and evaluation). We suggest that the CFES model remains important, but is not aligned with three concepts—governance, implementation and adjustment—that have taken on increasing importance. Adding these concepts to the model can help ensure that public health fulfills its potential as a proactive partner fully integrated into climate policy planning and action in the coming decade.

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.

OBJECTIVE Little research has examined user perceptions of medication warnings about driving. Consumer perceptions of the Australian national approach to medication warnings about driving are examined. The Australian approach to warning presentation is compared with an alternative approach used in France. Visual characteristics of the warnings and overall warning readability are investigated. Risk perceptions and behavioral intentions associated with the warnings are also examined. METHOD Surveys were conducted with 358 public hospital outpatients in Queensland, Australia. Extending this investigation is a supplementary comparison study of French hospital outpatients (n = 75). RESULTS The results suggest that the Australian warning approach of using a combination of visual characteristics is important for consumers but that the use of a pictogram could enhance effects. Significantly higher levels of risk perception were found among the sample for the French highest severity label compared to the analogous mandatory Australian warning, with a similar trend evident in the French study results. The results also indicated that the French label was associated with more cautious behavioral intentions. CONCLUSION The results are potentially important for the Australian approach to medication warnings about driving impairment. The research contributes practical findings that can be used to enhance the effectiveness of warnings and develop countermeasures in this area. Hospital pharmacy patients should include persons with the highest level of likelihood of knowledge and awareness of medication warning labeling. Even in this context it appears that a review of the Australian warning system would be useful particularly in the context of increasing evidence relating to associated driving risks. Reviewing text size and readability of messages including the addition of pictograms, as well as clarifying the importance of potential risk in a general community context, is recommended for consideration and further research.

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.

This paper presents findings from the rural and remote road safety study, conducted in Queensland, Australia, from March 2004 till June 2007, and compares fatal crashes and non-fatal but serious crashes in respect of their environmental, vehicle and operator factors. During the study period there were 613 non-fatal crashes resulting in 684 hospitalised casualties and 119 fatal crashes resulting in 130 fatalities. Additional information from police sources was available on 103 fatal and 309 non-fatal serious crashes. Over three quarters of both fatal and hospitalised casualties were male and the median age in both groups was 34 years. Fatal crashes were more likely to involve speed, alcohol and violations of road rules and fatal crash victims were 2½ times more likely to be unrestrained inside the vehicle than non-fatal casualties, consistent with current international evidence. After controlling for human factors, vehicle and road conditions made a minimal contribution to the seriousness of the crash outcome. Targeted interventions to prevent fatalities on rural and remote roads should focus on reducing speed and drink driving and promoting seatbelt wearing.

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...

In this study, the goals of the Australian Community Health Program were identified and operationalised. Measures of the communities' health were obtained before and after the health centres came into operation. A population from a comparison area in which community health centre services were not available is also examined. The findings fail to support the view that Brisbane community health centres influence community symptom levels. Further, there is no evidence that health centre activities have produced a decline in medical service utilisation. Stillbirth and neonatal mortality rates appear unaltered. Hospital admission rates declined in one intervention area but continued to increase in both the comparison and, at a lower rate, in the other intervention area. The apparent lack of impact of community health centres in Brisbane may, in part, be attributed to political and structural factors which have limited the number and range of intervention programs. Thus it cannot be assumed that these findings reflect upon the Community Health Program as a whole, but they do indicate that in some centres the Program may fail to address adequately some community health needs. 1981 Public Health Association of Australia

This article reports on the development of a school-based intervention to reduce risk taking and associated injuries. There is limited but important evidence that intervention design should ensure participation does not lead to an increase in target risk behaviors with some studies in alcohol and drug prevention finding unexpected negative effects. The short-term evaluation of Skills for Preventing Injury in Youth (SPIY) examined change in interpersonal violence, alcohol use, and transport-related risks. Intervention ( n = 360) and comparison ( n = 180) students were surveyed pre- and postintervention. A qualitative analysis based on focus groups (70 students) explored experiences of change. Findings indicate significant positive changes reinforced by students’ reports. A decrease in reported risk taking for the intervention group and an increase in the comparison group were observed. These findings endorse SPIY as a useful curriculum approach to reducing injuries and lend support to the future conduct of a long-term outcome evaluation.

Typically adolescents' friends are considered a risk factor for adolescent engagement in risk-taking. This study took a more novel approach, by examining adolescent friendship as a protective factor. In particular it investigated friends' potential to intervene to reduce risk-taking. Five-hundred-forty adolescents (mean age 13.47 years) were asked about their intention to intervene to reduce friends' alcohol, drug and alcohol-related harms and about psychosocial factors potentially associated with intervening. More than half indicated that they would intervene in friends' alcohol, drug use, alcohol-related harms and interpersonal violence. Intervening was associated with being female, having friends engage in overall less risk-taking and having greater school connectedness. The findings provide an important understanding of increasing adolescent protective behavior as a potential strategy to reduce alcohol and drug related harms.

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.

Each year in Australia many thousands of collisions occur between motor vehicles and animals, resulting in considerable vehicle repair costs, injury to persons, and loss of animal life. This paper reviews animal-related road crashes in Australia and presents data from the in-depth Rural and Remote Road Safety Study in North Queensland for serious casualties (n = 33) resulting from direct impact with an animal or swerving to avoid an animal on public roads. These crash types accounted for 5.5% of all eligible on-road serious casualties in the study and, hence, are considered to be an important issue that requires particular attention within rural and remote areas. Kangaroos and wallabies were the predominant species involved in these crashes (44.8%). Consistent with international studies, night-time travel was found to be a significant risk factor when comparing animal-related crashes to other serious injury crashes in the study. There were also a significantly higher proportion of motorcyclists (51.7%) than other vehicle occupants involved in animal-related serious crashes compared to all other serious injury crashes. Data matching to official Government records found underreporting of animal-related crashes to be an issue of concern. These findings are discussed in terms of countermeasures suitable for the Australian context and the need for consistent crash reporting across jurisdictions.

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.

The present study reports on a group of 132 recidivist offenders' stages of change and self-efficacy levels for changing and controlling both their drinking and drink driving behaviours. The majority of the sample reported being motivated to change their drink driving, but not their drinking behaviours. The sample also indicated high self-efficacy levels for the two behaviours, although a notable finding was that participants reported higher levels of control over their drinking rather than drink driving behaviours. Examination of the self-reported frequency of drink driving revealed that both motivations and self-efficacy levels were predictors of past offences and future intentions to drink and drive. The findings have direct implications for the management of repeat offenders, such as the inclusion of rehabilitation and alcohol treatment programs in sentencing outcomes for individuals who appear resistant to change.

ObjectiveDrink driving contributes to significant levels of injury and economic loss in China, but is not well researched. This study examined knowledge, drink driving practices and alcohol misuse problems among general drivers in Yinchuan. The objectives were to gain a better understanding of drink driving in Yinchuan, identify areas that need to be addressed, and compare the results with a similar study in Guangzhou.MethodsThis was a cross-sectional study with a survey designed to collect information of participants' demographic characteristics and their knowledge and practices in relation to drinking and driving. The survey was comprised of questions on knowledge and practices in relation to drink driving and was administered to a convenience sample of 406 drivers. Alcohol misuse problems were assessed by using the Alcohol Use Disorders Identification Test (AUDIT).Results Males accounted for the main proportion of drivers sampled from the general population (“general drivers”). A majority of general drivers in both cities knew that drunk driving had become a criminal offence in 2011, however knowledge of two legal blood alcohol concentration (BAC) limits was quite low. Less drivers in Yinchuan (22.6%) than in Guangzhou (27.9) reported having been stopped by police conducting breath alcohol testing at least once in the last twelve months. The mean AUDIT score in Yinchuan (M = 8.2) was higher than in Guangzhou (M = 7.4), and the proportion of Yinchuan drivers with medium or higher alcohol misuse problems (31.2%) was correspondingly higher than in Guangzhou (23.1%). In Yinchuan, males had a significantly higher AUDIT score than females (t = 3.454, p < .001), similar to Guangzhou. Multiple regression analyses were conducted on potential predictors of the AUDIT score (age, gender, monthly income, education level, years licensed and age started drinking). There were significant individual contributions of gender (beta = 0.173, p = 0.09) and age at which drinking started (beta = 0.141, p = 0.033), but the overall model for Yinchuan was not significant, unlike Guangzhou.ConclusionsThe results show that there are shortfalls in knowledge of the legislation and how to comply with it, and deficiencies in police enforcement. In addition there was evidence of drink driving and drink riding at high levels in both cities. Recommendations are made to address these issues.

In Australia, even though there are liquor laws that make it amongst other things, illegal to sell alcohol to persons under 18 years of age and to intoxicated persons, the research shows that there is not a high level of compliance with these laws. This study investigated police reports of enforcement of liquor laws in rural and urban Australia by surveying 270 rural and 336 urban operational police officers. The results showed that police directed most enforcement at individual drinkers in breach of the law rather than the venue that supplied the alcohol. Only 18% of rural and 14% of urban officers claimed to have enforced a breach by a vendor or licensee, whereas 62% of rural officers compared with 52% of urban officers had enforced a breach by an individual in the past 12 months. The enforcement behaviour of both rural and urban officers was significantly influenced by their self-reported knowledge of the liquor laws. In both locations the officers who were the most likely to enforce vendor or licensee...

BACKGROUND: This review examines the breadth of first aid training delivered to school students and the components that are age appropriate to adolescents. METHOD: Eligible studies included school-based first aid interventions targeting students aged between 10 and 18 years. Online databases were searched, for peer-reviewed publications available as at August 2014. RESULTS: A total of 20 journal articles were relevant to the review. Research supported programs with longer durations (3 hours or more). Most programs taught resuscitation alone and few included content that was context-specific and relevant to the target group. The training experience of the facilitator did not appear to impact on student outcomes. Incorporating both practical and didactic components was found to be an important factor in delivering material and facilitating the retention of knowledge. Educational resources and facilitator training were found to be common features of effective programs. CONCLUSIONS: The review supports first aid in school curriculum and provides details of key components pertinent to design of school-based first aid programs. The findings suggest that first aid training may have benefits wider than the uptake and retention of knowledge and skills. There is a need for future research, particularly randomized controlled trials to aid in identifying best practice approaches. Language: en

Much research has been conducted into aspects of the police workplace that contribute to stress for individual officers. The current paper examines the influence of worksplace and job characteristics on both officers' stress and their job satisfaction. Police officers recruited from two divisions of an Australian state police service (n=749) were surveyed. Results show that there was a positive relationship between organizational support and job satisfaction and a negative relationship between organizational support and job stress. Difficulty in dealing with organizational change led to lower job satisfaction and higher levels of job stress. Working long hours led to increased job stress but it did not lead to lower job satisfaction. In contrast, shiftwork led to lowered job satisfaction but it did not lead to job stress. Of particular interest in this study was the finding that the job content factor of dealing with dangerous and unpredictable duties was not predictive of job stress but in fact led to higher job satisfaction.

The current study tracks the drinking behaviour of new police recruits from their ®rst day in the academy, after 6 months of training, through to one year into training (n ˆ 177). Drinking behaviour was assessed with the AUDIT, a well-researched instru- ment for assessing risk of harm from drinking behaviour. The results showed that recruits' risk of harm from alcohol consumption increased as their training progressed. These ®ndings, based on a longitudinal methodology, suggest that the police service and training process introduces recruits into a culture of alcohol consumption which may impact on their individual consumption levels.

The current study surveyed members of an Australian state police service (N = 749), in order to assess what officers felt were the major contributing factors to alcohol consumption within the policing occupation. The study further examined which of these factors were actually predictive of risk of harmful drinking as measured by the Alcohol Use Disorders Identification Test - AUDIT (Saunders et al., 1993). Results showed that 30% of respondents were at risk of harm from excessive alcohol consumption. When asked to rate the importance of factors they felt contributed to their drinking, officers rated social factors such as celebration, and socializing with peers as the most important factors. However factors related to stress emerged as the most predictive of scores on the AUDIT. These findings highlight an often seen contradiction and have important implications for intervention strategies aimed at reducing alcohol consumption within the policing occupation. While officers appear to be drinking to reduce ...

This study examined aspects of the work environment, which may impact on individual police officers’ risk of harm from alcohol consumption. A self report survey containing demographic questions, the AUDIT and questions relating to perceived control over the job, overtime, pressure, boredom and job satisfaction was completed by 67 per cent of officers in an Australian state police service. The results of the current study indicate that gender, age and marital status, are individual risk factors for problem drinking, as has been shown in previous research. Within the policing context, years of service, job satisfaction, perceived control within the job and being an operational officer, also emerged as significant predictors of at risk alcohol consumption patterns. Findings further suggest that there is a strong norm of drinking at work or after a shift, which suggests a culture of acceptance of drinking within the workplace. This acceptance is strongly predictive of both risk of alcohol dependency and negative consequences from drinking within the police service. This study suggests directions for future research, which may lead to the introduction of informed interventions within the police service that could reduce officers’ risk of harm from alcohol consumption.

There has been little research examining the use of the Alcohol Use Disorders Identification test (AUDIT) as a workplace screening tool. In the current study a large scale sample (n = 4193) of police personnel completed the 10 AUDIT questions and two readiness to change questions. The sample represented 67% of all members of an Australian State Police organisation. Analysis of AUDIT scores showed that 65% of the sample scored in the low risk of hazardous alcohol consumption range, 32% (33% of males and 24% of females) scored in the at risk for harmful alcohol consumption range and 3% scored in the range indicating risk of alcohol dependence. Age emerged as a clear risk factor of hazardous drinking patterns. The 18 to 25 years age group recorded higher average alcohol consumption, higher rates of risk of abnormal drinking behaviour, higher rates of adverse consequences from drinking alcohol and higher total AUDIT scores than other age groups. This was consistent for both males and females. Of those scoring in the at risk range, 72.5% reported that they did not have a drinking problem. Sixty percent also reported that it would be easy to stop drinking. This study exemplifies how the AUDIT can be used to provide strong evidence for the need for work based intervention programs. Further it can be used to target particular groups within the organisation at risk of harmful alcohol use.