Community-Based Injury Prevention Interventions

Abstract

Community-based interventions offer a promising solution for reducing child and adolescent unintentional injuries. By focusing on altering behavior, promoting environmental change within the community, or passing and enforcing legislation, these interventions seek to change social norms about acceptable safety behaviors. This article systematically reviews 32 studies that evaluated the impact of community-based injury prevention efforts on childhood injuries, safety behaviors, and the adoption of safety devices. Interventions targeted schools, municipalities, and cities. Most relied on an educational approach, sometimes in combination with legislation or subsidies, to reduce the cost of safety devices such as bicycle helmets. Results indicate that community-based approaches are effective at increasing some safety practices, such as bicycle helmet use and car seat use among children. The evidence is less compelling that such interventions increase child pedestrian safety, increase adolescent vehicle safety by reducing drinking and driving behaviors, or reduce rates of several categories of childhood injuries. Strong evidence supporting the effectiveness of community-based interventions is lacking, in part because few studies used randomized controlled designs or examined injury rates among children and youths as outcome measures. Nonetheless, this review identifies common elements of successful community-based approaches that should be replicated in future studies. First, the use of multiple strategies grounded in a theory of behavior change is critical. Second, to maximize success, interventions should be integrated into the community and approaches should be tailored to meet unique community needs. Third, community stakeholders should be included in the development of community-based strategies. This community involvement and ownership of the intervention increases the likelihood of modeling and peer pressure, leading to widespread adoption of a safety behavior. Finally, when possible, a randomized controlled design should be used to maximize the trustworthiness of reported findings and aid decisions about where to invest resources in community-based approaches to injury prevention.

Prevenção e controle de injúrias físicas: saímos ou não do século 20?

“…A questão da idade é crucial: mesmo que o pediatra não seja capaz de modificar a idade de seus pacientes, pode sempre tentar, por Veja artigo relacionado na página 97 meio da orientação, minimizar o desacerto entre riscos específicos e fatores de resiliência. E há evidências de que isto funciona: a educação para a segurança é factível, tanto no âmbito individual quanto no comunitário 10,11 . Fonseca e colaboradores optaram por avaliar uma subamostra de sua coorte, durante um período muito restrito de seu desenvolvimento, justamente a faixa pré-escolar, na qual a incidên-cia de injúrias físicas costuma ser particularmente baixa.…”

Increased bicycle helmet use in Sweden: needs and possibilities

“…Conversely, the risk of using very rigorous inclusion criteria is that new interventions with potential effects could be missed. Notwithstanding, the general conclusions arrived at in section 1.4 agree well with the findings of other reviews conducted in recent years (27,(241)(242)(243)(244), one of which was also a systematic review (26).…”

“…The pre-law wearing rate in Motala was also high compared with the rates achieved by successful helmet programs for children in other countries. Two examples of such programs are as follows: the Seattle Bike Helmet Campaign in the United States, which succeeded in increasing helmet use among children aged 5-15 years from about 5% to 60% over a tenyear period (170,242); and the four-year helmet program for school children aged 5-12 in Montérégie, Quebec, Canada, which led to a rise in voluntary helmet wearing from about 1% to 33% (51).…”

A comunidade segura

“…6,8 The importance of discussions of the definitions, values and principles of community interventions should also be emphasized. According to Klassen et al, 9 communitybased interventions are aimed at geographically defined groups of individuals or communities, such as cities or schools; involve a collection of strategies that include: education and behavior modification; intervention in the environment and development of technology; legislation and its application. Educational and behavioral strategies aim to raise awareness of risks and the importance of safe behavior, in addition to offering encouragement and positive models.…”

“…9 Many authors believe that the success of health promotion is dependent upon proof of its effectiveness in public health. In contrast, others believe that evidence-based medicine is inappropriate for the field of health promotion.…”