Injury and risk-taking behavior - a systematic review

There is a substantial body of work in the scientific literature discussing the role of risk-taking behavior in the causation of injury. Despite the quantity of diverse writings on the subject most is in the form of theoretical commentaries. This review was conducted to critically assess the empirical evidence supporting the association between injury and risk-taking behavior. The review found six case-control studies and one retrospective cohort study, which met all the inclusion criteria. Meta-analysis was not possible due to the diversity of the independent and outcome variables in each of the studies reviewed. Overall the review found that risk-taking behavior, however it is measured, is associated with an increased chance of sustaining an injury except in the case of high skilled, risk-taking sports where the effect may be in the other direction. Drawing specific conclusions from the research presented in this review is difficult without an agreed conceptual framework for examining risk-taking behavior and injury. Considerable work needs to be done to provide a convincing evidence base on which to build public health interventions around risk behavior. However, sufficient evidence exists to suggest that effort in this area may be beneficial for the health of the community. (C) 2003 Elsevier Science Ltd. All rights reserved.

Alcohol use and risk taking among regular ecstasy users

We examine alcohol use in conjunction with ecstasy use and risk-taking behaviors among regular ecstasy users in every capital city in Australia. Data on drug use and risks were collected in 2004 from a national sample of 852 regular ecstasy users (persons who had used ecstasy at least monthly in the preceding 6 months). Users were grouped according to their typical alcohol use when using ecstasy: no use, consumption of between one and five standard drinks, and consumption of more than five drinks (binge alcohol use). The sample was young, well educated, and mainly working or studying. Approximately two thirds (65%) of the regular ecstasy users reported drinking alcohol when taking ecstasy. Of these, 69% reported usually consuming more than five standard drinks. Those who did not drink alcohol were more disadvantaged, with greater levels of unemployment, less education, higher rates of drug user treatment, and prison history. They were also more likely than those who drank alcohol when using ecstasy to be drug injectors and to be hepatitis C positive. Excluding alcohol, drug use patterns were similar between groups, although the no alcohol group used cannabis and methamphetamine more frequently. Binge drinkers were more likely to report having had three or more sexual partners in the past 6 months and were less likely to report having safe sex with casual partners while under the influence of drugs. Despite some evidence that the no alcohol group were more entrenched drug users, those who typically drank alcohol when taking ecstasy were as likely to report risks and problems associated with their drug use. It appears that regular ecstasy users who binge drink are placing themselves at increased sexual risk when under the influence of drugs. Safe sex messages should address the sexual risk associated with substance use and should be tailored to reducing alcohol consumption, particularly targeting heavy alcohol users. The study's limitations are noted.

Does anticipation training affect drivers' risk taking?

Skill and risk taking are argued to be independent and to require different remedial programs. However, it is possible to contend that skill-based training could be associated with an increase, a decrease, or no change in fisk-taking behavior. In 3 experiments, the authors examined the influence of a skill-based training program (hazard perception) on the fisk-taking behavior of car drivers (using video-based driving simulations). Experiment 1 demonstrated a decrease in risk taking for novice drivers. In Experiment 2, the authors examined the possibilities that the skills training might operate through either a nonspecific reduction in risk taking or a specific improvement in hazard perception. Evidence supported the latter. These findings were replicated in a more ecological context in Experiment 3, which compared advanced and nonadvanced police drivers.

Psychosocial risk factors for pregnancy risk-taking in young women in emerging adulthood: Evidence from the Australian Longitudinal Study on Women's Health

This study represents the first longitudinal investigation of distal psychosocial predictors of pregnancy risk-taking in young Australian women. Participants were from the Australian Longitudinal Study on Women's Health. Two mail-out surveys assessing sociodemographic, education/competence, psychosocial wellbeing, and aspiration/identity factors, were completed at ages 18 and 22 by 1647 young women in emerging adulthood, and a third survey assessing pregnancy risk-taking behaviour was completed by a subsample of 90 young women at age 24. Higher psychosocial distress at age 22 was a risk factor for pregnancy risk-taking at age 24 (beta=0.29-0.38). Post hoc analyses suggested that the strongest component of psychosocial distress when predicting pregnancy risk-taking was higher depressive symptoms (beta=0.44-0.68). Demographic, education, unemployment, and future aspirations factors at age 18 and 22 were unrelated to pregnancy risk-taking at age 24.

Risk taking from the participant's perspective: The case of driving and accident risk

Although perceived health risk plays a prominent role in theories of health behavior. its empirical role in risk taking is less clear. In Study 1 (N = 129), 2 measures of drivers' risk-taking behavior were found to be unrelated to self-estimates of accident concern but to be related to self-ratings of driving skill and the perceived thrill of driving. In Study 2 (N = 405), out of a wide range of potential influences, accident concern had the weakest relationship with risk taking. The authors concluded that although health risk is a key feature in many theories of health behavior and a central focus for researchers and policy makers, it may not be such a prominent factor for those actually taking the risk.

Injury related risk behavior - a study of Australian skydivers

Risk taking behaviour has been identified as an important host-related determinant of injury in young adults. The aim of this study is to clarify the relationship between the two key elements of risk taking behaviour - ie, risk assessment and risk acceptance - in participants of a high risk sporting activity. Skydivers registered with the Australian Parachute Federation were sampled at several jump meetings held at three 'drop-zones' in North Eastern Australia. A cross sectional survey of 215 skydivers ascertained each subject's risk assessment of each of nine hypothetical sky diving scenes and whether or not they would jump in the described conditions. Variables which independently predicted an individual's risk assessment were age group (p < 0.05), gender (p < 0.05) and scene details (p < 0.001). Risk assessment was found to be a statistically significant predictor of the decision to jump, with a 22% decrease in the odds of jumping with every unit increase in risk assessment (OR = 0.78: 95% Cl; 0.76, 0.80). Gender was also found to be a statistically significant predictor of the decision to jump, with males being 19% more likely to jump than females, after controlling for age, experience, currency and risk assessment (OR = 1.19: 95% CI; 1.04, 1.38). The importance of these results is that, by quantifying the relationship between two key elements of risk taking behaviour and several important host factor determinants, they facilitate more informed discussion about the possible role of risk taking behaviour in the causation of injury.

Methadone maintenance treatment reduces heroin injection in New South Wales prisons

The purpose of this study was to examine whether methadone maintenance treatment reduces injecting risk behaviour land therefore transmission of blood-borne viral infections) among prisoners in New South Wales (NSW), using comparison of retrospective reports of drug use in prisons for people who received standard drug treatment, time-limited methadone treatment and methadone maintenance treatment, The setting for the study was the NSW prison system. One hundred and eighty-five injecting drug users who had been recently released from NSW prisons were recruited in 1993, Self-reported drug use and injecting risk behaviour were compared in inmates who received standard drug treatment (counselling), time-limited methadone treatment and methadone maintenance treatment. HIV status was determined by serology, Intervention comprised high and low dose methadone treatment and counselling. The groups were similar in terms of most basic demographic characteristics but subjects who had been maintained on methadone reported a significantly lower prevalence of heroin injection, syringe sharing and scored lower on an HIV Risk-taking Behavioural Scale than subjects who received standard drug treatment and time-limited methadone treatment, This study suggests that methadone treatment is associated with reduced injecting risk behaviour in prison with adequate (greater than 60 mg) dose and duration in treatment. These treatment conditions are known to increase effectiveness in community-based methadone programmes. Prospective studies are required to evaluate the effectiveness of methadone programmes in the prevention of HIV and other blood-borne viral infections among IDU prisoners.

Volatile solvent use among western Australian adolescents

Semistructured interviews were conducted with 40 adolescents who reported inhaling volatile solvents. Their average age was 14.2 years, and they used a range of substances. All were aware of the short-term health risks involved in volatile solvent use, and most reported experiencing ill effects, such as headaches and vomiting. Users were found to be organized into groups and peer networks, which often were involved in theft, prostitution, and other risk-taking behaviors. More chronic users had higher status within the group. Suggestions pertaining to intervention were obtained, and these are discussed in light of the findings.