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Journal Issue: Unintentional Injuries in Childhood Volume 10 Number 1 Spring/Summer 2000

Community-Based Injury Prevention Interventions
Terry P. Klassen J. Morag MacKay David Moher Annie Walker Alison L. Jones

Evaluating Community-Based Injury Prevention Strategies

Studies were included in this review if they met the following criteria: (1) the study included a control group that did not receive the intervention, (2) the target population was between 0 and 19 years of age, (3) the study examined the effectiveness of a community-based intervention, and (4) the study reported injury rates or change in an injury-reducing behavior. (See the Appendix at the end of this article for details about the search strategy, methods, and analysis used in this systematic review.)

Although randomized controlled trials (RCTs) are the study design most likely to provide unbiased estimates of the impact of interventions (see the article by DiGuiseppi and Roberts in this journal issue), the review also included nonrandomized comparison group studies for two reasons. First, a previous review of community-focused interventions found that most such studies did not use a randomized design to evaluate program impact.1 Second, the logistics of randomization can be complicated in community-based injury prevention programs. Certain interventions such as legislation may defy randomization at the community level and require a comparison at a state or country level.

Thirty-two trials that evaluated the effect of a community-based injury control intervention on child injury rates, safety behaviors, or the use of safety devices were identified in this review.2–33 This article focuses on the 28 studies targeting bicycle helmet use, automobile restraint use, pedestrian safety, general injury prevention, and adolescent alcohol use and vehicle safety (see Tables 1 to 5). The four other trials were aimed at reducing the frequency of play with guns,30 reducing football injuries,31 improving road safety behaviors of bicyclists,32 and improving burn prevention practices.33 Because only one study addressed each of these outcomes and none of the interventions had a positive impact, these studies are not discussed further in this review. Of the 28 remaining studies, 6 were RCTs,2,3,17,21,22,28 and 22 were nonrandomized controlled trials.4–16,18–20,23–27,29 Most of the studies examined safety behaviors; only four examined actual injuries.12,23–25