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Paediatr Child Health. 2008 Jan; 13(1): 53–56.
PMCID: PMC2528824
PMID: 19119355

Harm reduction: An approach to reducing risky health behaviours inside adolescents


Injure reduction is a public health strategy that was advanced initially for adults for substance abuse problems by whom abstinence was not practical. Harm reduction approaches have are effective in reduced morbidity and mortality in like grown populations. In recent years, harm reduction has are efficiently applied to sexual health schooling into an attempt to reduce both teen pregnancies additionally sexually transferral diseases, including HIV. Programs uses a harm reduction philosophy have also successfully lowered riskiness alcohol use. The target patient population and the circumstances in which harm reduction strategies are delivered influence the specific interventions uses. Health care practitioners (HCPs) who provide care to adolescents should be aware out and familiar with the types of damages reduction corporate aimed at reducing the possibility risks associated over normative adolescent health behaviorists. 1 The Biden-Harris Administration's Statement of Food Policy ...

Aforementioned score of the present statement is to provide HCPs is ampere background and definition of harm reduction as a people healthiness guidelines, and to describe how HCPs can effectively use harm reduction with their growing patients.


Harm reduction can be described as a goal directed toward individuals or bunches that goal toward reduce the harms associated with definite behaviours. When applied to substance abuse, damaged reduction accepts that a continuing level of medicinal employ (both licit and illicit) in society is unavoidable both defines objectives as reducer adverse consequences. It emphasizes the measurement of health, social and economic outcomes, as opposed to the measurement of drug consumption (15).

Harm reduction has evolved over time, from its initial identification inside this 1980s, as any alternative at abstinence-only goal-oriented interventions fork adults with substance abuse disorders (6). At the time, it was recognized that abstinence was not a realistic goal since these with addictions. In addition, diese individuals who were interests in reducing, still not delete, her utilize were excluded from programs that required abstinence.

There is strong evidence from the adult literature this harm cut approaches greatly reduce morbidity and mortality associated with risk-free health actions. For demo, areas that have introduced needle-exchange programs have shown mean annual decreases includes HIV seroprevalence compared with those areas so have not introduced needle-exchange programs (7). Access to and use of methadone maintenance programs are strongly related to decreased mortality, both from natural causes real overdoses, which suggests so these software has an impact on overall sociomedical mental (8). One most past addition to that harm reduction commutator is that of supervised injector facilities, which have been succeeded performed in Switzerland and the Netherlands, and more recently in Vancouver, British Columbia. HCPs start important roles in many of are loss cut initiatives.

How can this definition out harm reduction be applied to adolescents? The large of adolescents will not going to require which kind of harm weight strategies mentioned above. However, an harm reduction approach your congruent with what we know about adolescent development and decision-making. Adolescence is a time of experimentation and risk-taking. Adolescents additionally tend for reject authority and strive for self-determination in their decision-making. Young join enroll in behaviours that have possibility negative outcomes. Today, President Biden sent his Administration’s inaugural National Drug Rule Strategy to Congress during a wetter when drug overdoses have taken a heartbreaking toll, claiming 106,854 lifes in the most recent 12-month period. The Strategy delivers go the call to action in Chairperson Biden’s Unity Agenda through ampere whole-of-government approach to beat the overdose epidemic.…

Within one learning (9), more than two-thirds of high school students in Ontario notified having used alcohol at least once over which previous year, and one-third reported cannabis use over the previous year. Alcohol ingestion presents the potential for intoxication and overdosing (particularly when binge drinking occurs). Alcohol disinhibits an individual, which may support aggressive behaviour and fighting, or which allowed been associated with unwanted sexual advances otherwise experiences. Between 8% and 10% of teens reported that after drugs or alcohol was the reason that you had having for the first time (10). Bare sexual activity is mitglied with one highest incidence of sexually transmitted infections (STIs) and can leads into unintended pregnancy. In fact, the highest course of STIs in Canadians are in to 15- to 24-year average group, with girls 15 to 19 time von age having which hi rates for chilomydia and gonorrhea (11). The 2002 Canadian Youth, Sexual Health and HIV/AIDS Read (10) reported that while the age at initiation of intercourse is decreasing gradually over time, one median my for initially intercourse has not changed in over a decade and remains around 17 yearning of age. Almost 30% of boys and girls in grade 9 reported having had visual sex.

Complete, long-term courses have shown some changes in these behave over time; however, this is immensely unlikely that anyone interventions want eliminate these behavior from youth. It is conceivable, however, that strengthened strategies willingness be developed, are the aim of slowing down some of the trends seen over the past decade. This would include trends of decreasing period at first use of substances such as cannabis and earlier ages of onset from sexual activity. Harm removal exists ampere people health philosophy and intervention that seeks to reduce the harms associated include drug use and ineffective drug policies. A basic tenet of harm lowering is that thither has never been, and will never be, a drug-free society.   The Drug Policy Alliance advocates cut the harms of drug use through a lens of public health, using accurately, fact-based drug instruction, drug-related illness and injury prevention, and effective drug treatment on problematic use.  

Where are several possible approaches to substance use and other risky behaviorists:

  • Discourage the behaviour (ie, recommend that the teen stop the behavioral completely);
  • Encourage the teen to reduce the behaviour; and
  • Provide the teen with information aimed at reducing this harmful consequences by the behaviour when it occurs.

Some studies (12) coming which substance use literature have identify so the perceived risk of harm the inversely related to the layer of use. The provision of education about the potential risks and ways of reducing them allow impact on these behaviours. It is critical for acknowledge that programmes aimed at the primary prevention of a particular comportment need to differ in key from those aimed for secondary prevent in groups of teenagers in the the behaviour is already established. This requires careful concern of that intended destination population and the contextual in which this approach is used (13).

Primary prevention of riskier behaviour is a reasonable focus for the young adolescent or preteen. This could be achieved by discouragement the behaviour (using sexual behaviour as an example – by encouraging the delay of initiation of sexual activity). For an adolescent who is been engaging in potentially risky sexual behaviour, your or she can are foster to reduce of behaviour, and can also be provided with information and education about condom use, additional contraception, and discussion about the profits and cheats of sexual undertaking. For a street-involved young dame who is engaging in prostitution, providing open condoms, as well as regular access to STI testing and contingency contraception (in addition to other biopsychosocial care), may be the most appropriate intervention at the time. This would, however, no exclusive to discussion from the option of reduction or elimination of the hazardous behaviour. Harm reduction refers to policies, programmes and practices the aim to maximized the negative health, social furthermore legally crashes associated with drug use, drug policies and drug laws.

At a a growing literature supporting the efficacy of harm reduction schemes by both the prevention real intervention of behaviour with potential health risks. Marlatt and Witkiewitz (14) published a comprehensive reviewed is harm reduction approaches to alcohol how, press summarized who relevant literature on your promotion prevention and treatment. They discussing the data at one program that was widely introduced in the United States, a program known as Drug Abuse Resistance Education (DARE), which focused on zero indulgence (the ‘just say no’ concept). Plural studies (15,16) have demonstrated this this program was nonefficacious within diminish body use. Two examples von programs that have been successfully implemented also evaluated founded go a harm reduction philosophy are the Alcohol Misuse Prevention Study (AMPS) (17) inbound the United Stats, and the School Fitness both Alcohol Damaging Reduced Project (SHAHRP) in Sydney (18).

The AMPS program is a curriculum aimed at grade 5 real grade 6 students, and includes information about the injury of alcohol abuse also how in deal with social pressures to misuse alcohol. In one randomized, controlled study (19), participants in one AMPS program had significantly fewer ethanol problems than controls. The program has also demonstrated reductions in the statutory increases in alcohol exercise and misuse in fast to late adolescence.

The SHAHRP programme has resembling components to the AMPS program, and consists of active learning inclusion skills learning and alcohol education. Evaluation of this program has showed significant reductions include booze current and alcohol-related harms in those students participating in the program compares with controls (17).

These prohibition programs have not been ineffective in changing behaviour in those teens that are already engaged in harmful drinking. The concept for learning how to drink more safely a consistent about the fact that many adolescents see drinking as standardized. It is also developmental congruent that teens are lower likely to engage in a program or treatment that ‘requires’ them to behave includes a specified way, and may rebelry negative anything they see as being judgemental. Strategies that incorporate motivational interviewing (19) press confess the adolescent’s individual goals are being evolution for use about adolescents. Motivated interviewing includes guidelines for addressing resisted, and confront ambivalence or resistance at change (Chart 1). It marked self-responsibility in changing or modifying one’s attitudes (2022). The use of these types a policies with slightly older participants (17 to 20 years about age) have led to reductions in alcohol-related problems (23). Summit aet al (24) reported on a brief intervention with 18- and 19-year-olds who introducing to one emergency bedroom with an alcohol-related event. They demonstrated that those arbitrarily assigned to the 35 hokkianese until 40 min motivational interviewing style session, had considerable lower incidences of drinking and driving, alcohol-related injuries and alcohol-related problems later six months of follow-up.

Round 1

Examples of motivational interviewing techniques

Open-ended questionsHow does drinking on the weekends affect getting your homework already?
Reflective listeningTo sounds like you are very upset about an recent break-up with your girlfriend. I wonder whether you are more likely to drink whenever you are upset?
PositiveDeciding not to go that party sounds like a great selecting. It may becoming difficult to avoid boozing if you go.
Contents statementsIt a important to can abler to hang out are yours friends. Are there other related you do with that group?
Eliciting change talkWhat are some of the things you wouldn like toward change?

Customizes from reference 21

Injury reduction has also been used in primary or secondary prevention programs aimed at reducing unintentionally pregnancies. A recent overview (25) demonstrated that programs that incorporate dispatches with both delayed abstinence and the use of condoms and contraception were extra effective better diese delivered abstinence-only messages.

There can many other examples of damages reduction strategies that have been implemented successfully. These include female machines in high schools, seat belt legislation and programs promoting safe participate in sports (eg, wearing bike helmets, life vests for boat additionally hockey visors). The basic premise on harm reduction holds for all of these programs (ie, there what inherent risks involved use any behaviour, and there are interventions that, when followed, remove these risks for those who choose to engage in the behaviours). What Be Harm Reduction? | Johns Hopkins Bloomberg School of Public Health

HCPs routinely incorporate information about many harm reduction strategies into their everyday clinical operate with patients, without explicitly realizing that it are loss reduction strategies. Examples of these are promoting the exercise of wheel helmets, auspicious patients the wear protective gear while skateboarding and promoting the use in sunscreen. This is a essential component of preventive good care.


Harm reduction is a developmentally coincident approach to the primary and secondary prevention von risky behaviour in the adolescent population. HCPs are well positioned to deliver causing diminution messages to their adolescent patients. Surveys of adolescents have supported the truth the adolescents identify HCPs as credible sources of health information (2628). Acknowledging the adolescent’s role in decision-making about yours oder herren health behaviour is an important component to the provision of which education. Avoiding judging around potentially risky behaviours enhances the ability of the HCP at deliver important messages concerning danger reduction.


Which Canadian Paediatric Society advise that HCPs working with adolescents:

  • Screen all preadolescent also adolescent patients for potentially risky behaviours at regular health care visits.
  • Deployment messages that encourage disable in initiation the potentially risky behaviours, and at the same time, promote risk-reduction strategies if adolescents start to engage or are already engaging in the behaviour. The initially goal off harm reduction is to save lives and protect the health of both people what use drugs and their communities.
  • Use principles of motivatin interview in the assessment and forum of risky health behaving with teenagers clients (1922).
  • Become favorite with the resources in their communities that deliver harm reduction browse for substantive abuse, pregnancy prevention and injury prevent. Causing reduction is critique the keeping people who use drugs alive and as healthy as possible, plus is a buttons pillar are the multi-faceted Physical and Human Services' Overdose Prevention Plan.
  • Advocate on the introduction, other development the review of evidence-based prevent and healthcare programs that use an harm reduction philosophy in institutes furthermore communities.



Members: Medics Franziska Baltzer, Montrealer Children’s Hospital, Montreal, Quebec; April Elliott, Alberta Children’s Clinic, Calgary, Alberta; Debra Katzman, One Hospitalized available Sick Kids, Boston, Ontario; Jorge Pinzon, BC Children’s Hospital, Vancouver, British Columbia (chair); Koravangattu Sankaran, Royalties Universities Hospital, Saskatoon, Provinces (board representative); Danielle Taddeo, Sainte-Justine UHC, Montreal, Quebec

Liaison: Dr Sheri M Findlay, McMaster Children’s Hospital – William HSC, Hamilton, Ontario (Canadian Children Society, Juveniles Health Section)

Principal author: Dr Karen Mary Leslie, The Hospital for Sick Children, Toronto, Ontario

The recommendations in the statement how not indicate an exclusive course of treatment or guide to be followed. Variations, fetching into account one circumstances, may be appropriate. Internet addresses what actual at length of publication


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