The role of biobehavioral and psychosocial development in adolescent injury and violence prevention: Toward a developmental approach to intervention
Unintentional and intentional injuries are responsible for 70% of mortality in adolescence, more than all other causes of death combined. In adolescence, there is a complex interaction between physical, cognitive, and psychosocial developmental processes and the environment. This interaction results in a period of heightened risk taking and consequent vulnerability to injury. Studies of the developing brain indicate that the frontal lobes, responsible for planning, response inhibition, foreseeing consequences, and emotional regulation, may not be fully mature until the early 20s. The nature of biobehavioral development in adolescence reaffirms that adolescents are not older children or younger adults, but their needs with respect to injury intervention are unique.
Injury prevention relies on three strategies to address injuries across the lifespan: (1) modifying the physical environment; (2) legal and/or regulatory approaches; and (3) educational behavioral interventions. Among adolescents, the most prevalent intervention strategy is education, particularly education aimed at reducing or eliminating risk behavior. However, the utility of educational and behavioral strategies with adolescents has not been investigated in light of their unique developmental needs. This study critically examined the assumption that most adolescents can assimilate health-related information effectively, and will modify their behavior accordingly.
This study was conducted in several parts. After reviewing and synthesizing the developmental literature and specifying its relationship to injury prevention, the research involved conducting a systematic review of adolescent injury interventions published between 1995 and 2004. The review provided an overview of adolescent injury prevention interventions, and characterized them with respect to intervention approach, intent, and target audience. Using interventions as the unit of analysis, a new case study method was developed and used to build a theory of what constitutes developmentally appropriate adolescent injury prevention programs.
The results of this study suggest that developmental appropriateness is essential for program success. Educational interventions that require adolescents to perceive and understand risks and modify their behavior accordingly, are developmentally inappropriate and unlikely to be successful. The practical and policy implications of these findings are considered, including the need to use environmental and policy interventions to provide "surrogate frontal lobes" for adolescents during periods of highest risk.