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Adolescent injury prevention and clinicians: time for instant messaging. Physicians can help to reduce pointless and early deaths.

Slightly more than 50% of all deaths among children between the ages of 1 to 14 years and almost 75% of deaths among youths aged between 15 and 24 years are not caused by disease. They are caused by injuries, which include unintentional injuries (the term preferred to accidents which implies randomness and fatalism), suicides, and homicides. In fact, many strategies to prevent injury are more effective than many medical interventions.1,2 Because rates of acute and chronic diseases are low in this age group, injuries are unmasked as the clear preventable cause of death that physicians must face. Family physicians, pediatricians, and internists can all play a role to introduce these strategies to patients during clinical encounters. 
 
What can primary care physicians who care for adolescents do to prevent injuries among their patients? Systematic reviews show there have been few randomized controlled trials to determine if counseling by physicians can improve practices to prevent injury among adolescents or their parents.3,4 There is evidence, however, that physicians can improve parental practices with smaller children, so the lack of evidence should not be taken as a signal to retreat. Clinicians use anticipatory guidance to persuade children, adolescents, and parents to change behavior and to adopt behaviors to promote health. The same principles apply toward injury control. Often, counseling with regard to injury prevention involves promotion of the use of a piece of technology (for example, the use of seat belts, helmets, and smoke detectors). 
 
Physicians should screen adolescents for problems related to alcohol use and to refer them for treatment if any problems are detected.5,6 Recent evidence suggests that early intervention after trauma incidents involving alcohol misuse can reduce the risk of injury recurrence by about 50%.7 Brief interventions include giving facts and feedback about a behavior, clearly recommending a change in behavior, presenting options to achieve this change, checking and responding to the reaction of the adolescent, and providing follow-up care.8,9 
 
Parents of teens have an important role to play in reducing the risk of road injuries in their children. They should try to provide vehicles for their children to drive that protect occupants well during crash (see http://www.hwysafety.org/vehicle_ratings/ratings.htm for crash ratings), and restrict their teen's exposure to night driving, especially with other adolescent passengers. 
 
Any parent who owns firearms should restrict their access by locking them in secured storage or placing them in a combination gun safe. It is recommended to avoid keyed devices because adolescents know where to find keys. Parents should strongly consider removing firearms from the home if any member is a substance misuser or has a mental illness. 
 
How effective these measure are in reducing the risk of death among adolescents is largely unknown. Some evidence shows, however, that the use of smoke alarms can reduce the risk of death by between 50% and 70%.10 One smoke alarm should be placed on each floor of the home, and the alarm should be connected to the electrical circuit or powered by long lasting lithium batteries, if possible. Other key measures to prevent injury are outlined below (see box), along with their risk reduction of death. 
 
Adolescence is a developmental period characterized by behavior that involves taking risks. Some of this behavior is associated with a misperception of the risks associated with certain activities. Physicians can help by providing accurate information to both adolescents and their parents about the magnitude of risk reduction afforded by key measures designed to prevent injury.