Risk and Protective Factors: Bridging the Gap between Unintentional Injury and Violence Prevention

Transcription

1 Risk and Protective Factors: Bridging the Gap between Unintentional Injury and Violence Prevention Sallie Thoreson Dept of Public Health and Environment

2 Injury, Suicide and Violence Prevention are often approached as separate programs

3 States address Unintentional Injury and Violence Prevention 50/51 states address both programs. 94% of programs are in state health departments. 58% of programs are housed with health promotion, disease prevention, community health.

4 States address both Unintentional Injury and Violence Prevention Fire/Burns Poisoning Falls TBI Motor vehicle Child MV 35% 37% 45% 45% 61% 63% Homicide Partner Violence Sex assault Suicide 31% 37% 59% 65% 0% 20% 40%60% 80% 0% 20% 40% 60% 80%

5 Public Health Model

6 Core Competencies for Injury and Violence Prevention Core Competency #9 Demonstrate the knowledge, skills and best practices necessary to address at least one specific injury and/or violence topic and be able to serve as a resource regarding that area. d. Describe major risk and protective factors.

7 Socio-Ecological Model (Core Competency #3g)

8 Risk and Protective Factors Risk Factors Increase likelihood of engaging in risky behavior Factors that put people at risk for an injury Protective Factors Decrease likelihood of engaging in risky behavior Factors that protect people from an injury Buffer/interrupt/prevent risk factors Promote healthy behavior

9 Individual Violence Risk & Protective Factors Risk Factors Family history Family stress & distress Individual medical history Negative feelings Life stressors Teen pregnancy Protective Factors Skills in problem solving, conflict resolution, empathy Self esteem Resiliency Perceptions of social support Ethnic identity

10 Interpersonal Violence Risk & Protective Factors Risk Factors Social isolation of family Poverty Family disorganization Exposure to negative behavior Peer pressure Low parental education Poor school environment Protective Factors Stable family/nurturing Family rules Child monitoring Adequate employment, housing School connectiveness

11 Community Violence & Protective Factors Risk Factors Community violence Weak sanctions & laws Society norms Availability of alcohol/drugs Economic deprivation Few neighborhood facilities/resources Protective Factors Stable community Supportive programs for families Positive society norms Neighborhood cohesion Access to care

12 Available Violence Prevention Grants Sexual Violence Prevention: Targeting Modifiable Risk Factors for Sexual Violence Address relationship and community factors directly or in conjunction with individuals risk factors Identifying Neighborhood Level Protective and Promotive Factors for Youth Violence identify the community level constructs, attributes, and processes that exert promotive and protective effects

13 Individual Risk Factors Family Risk Factors

14 Peer/School Risk Factors Community Risk Factors Individual/Family Protective Factors Peer/School Protective Factors

15 Age-related decreases Men Health conditions Seatbelts Self-limit driving Don t drink & drive

16 Literature Review of Public Health and Risk and Protective Factors American Journal of Public Health ( ) 2009) Substance Abuse 5 Mental Health 5 Sexual Behavior - 5 Suicide 1 Injury & Violence 1 Physical Activity 1 Other health conditions - 7 Injury Prevention ( ) 2009) Violence 3 Motor Vehicle 2 Smoke alarms 2 Suicide 2 Falls 1 Drowning - 1

17 Follow-up of School-based Drug Abuse Prevention Program Background: Problem behaviors stem from common risk factors Program: Teach resistance skills, build self- esteem, problem solving Evaluation: Driving record 6 years later Conclusion: program students less likely to have violations on driving record Inspiration Griffin KW, Botvin GJ, Nichols TR. (2004). Long-Term Follow- Up Effects of a School-Based Drug Abuse Prevention Program on Adolescent Risky Driving. Prevention Science,5(3),

18 Risk and Protective Factors for Falls in the Home Risk Factors Hazards in the home» Stairs & steps» Ladders» Bathrooms High risk age groups» Older adults & children» Co-morbidity Practices & preferences of residents Protective Factors Protective devices» Window bars» Safety gates» Stair railings» Bathroom grab bars Home visits Financial assistance Marshall SW, Runyan CW, Yang J, et al. (2005). Prevalence of Selected Risk and Protective Factors for Falls in the Home. Am J Prev Med,28(1),

19 Risk and Protective Factors for Overweight in Adolescents Risk Factors Fast food Poor body image Weight-teasing by parents and peers Poor nutritional knowledge Physical inactivity Protective Factors Self-esteem Self-efficacy Family meal env. Regular meals Healthy food available Physical activity Neumark-Sztainer DR, Wall, MW, Haines JE, et. al. (2007). Shared Risk and Protective Factors for Overweight and Disordered Eating in Adolescents. Am J Prev Med,33(5),

20 Interventions on bullying and emotional well being covering whole schools can be more effective at reducing smoking than single issue smoking programmes. Viner R, Macfarlane A. (2005). ABC of Adolescent Health Promotion. BMJ,330,

21 Risk and Protective Factors Shared between Programs Risk factors Risk-taking, low perception of benefits Peer and family pressure Community norms Protective factors Self-esteem, self efficacy Supportive family environment Community programs

22 Risk and Protective Factors for Teen Motor Vehicle Injuries Risk Factors Age Risk taking Lack of seatbelt use Distractions Passengers/peers School/family needs Driving culture Protective Factors Decreased driving Parental involvement Family rules School culture GDL & Enforcement Transportation alternatives

23 Risk and Protective Factors for Older Adult Fall Prevention Risk Factors Home hazards Co-morbidities Fear of falling Polypharmacy Perceptions of aging Social isolation Physical inactivity Protective Factors Home modifications Drug/vision review Hip protectors Self-efficacy Social programs Balance retraining Active community environments Healthy aging

24 Risk & Protective Factors Risk & Protective Factors can be the bridge Unintentional Unintentional Injury Prevention Prevention Violence Violence and Suicide Suicide Prevention Prevention Other health promotion promotion programs programs

25 Wouldn t t it be nice.. Interventions on bullying and emotional well being covering whole schools can be more effective at reducing smoking than single issue smoking programmes Interventions on shared risk and protective factors covering whole communities can be more effective at reducing risky behaviors than single issue programs.

26 How Unintentional Injury Prevention could use Risk & Protective Factors Learn from Suicide and Violence Prevention programs. Broaden programs to multi-facetted strategies. Emphasize relationship and community protective factors. Ask other programs to use injury prevention evaluation elements. Identify shared risk and protective factors with other programs. (Core Competency #5i)

27 Conclusions Many opportunities for collaboration- Injury, Suicide & Violence Prevention Many opportunities for integration- other health programs Can increase visibility and funding

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