All the studies reviewed include at least one of the outcomes listed below.
An intermediate outcome would be crash events, or violations. An observed behavior
would be seat belt use, helmet use, etc. We did not review studies which used
self-reported outcomes or changes in beliefs, attitudes or knowledge. For example
the success of a campaign to increase bicycle helmet use could be based on observations
but not self reported use.
Outcomes Evaluated in Reviewed Studies
Outcomes Excluded from Reviews
- Risk of death
- Risk of hospitalization
- Risk of injury requiring ED Care
- Risk of injury requiring physician care in other setting
- Change in injury severity
- Change in intermediate outcomes (please specify, e.g. reduction in crash
or fall events)
- Change in measured (observed) behavior (please specify, e.g. wearing bicycle
- Change in costs
These outcomes were excluded because there is substantial evidence that changes
in knowledge, attitudes and beliefs do not correlate with changes in actual behavior
and a reduction in injuries ( see references below).
- Changes in knowledge
- Changes in attitudes
- Changes in beliefs
- Changes in self-reported behavior
Reported behavior change is not as reliable as directly observed behavior. For
example, individuals over-report seat belt use when compared to actual observations
of seat belt use (Stulginskas JV, Verreault , Pless IB. A comparison of observed
and reported seat belt use by children and adults. Accid Anal Prev 1985;
17:381-6.). Likewise, recent data indicate that individuals over-report bicycle
helmet use ( ref ). We therefore have chosen not to include reports in
which self-reported behavior change is the only outcome measure.
- Assum T. Attitudes and accident risk. Accid Anal Prev 1997;
- Joshi MS, Beckett K, Macfarlane A. Cycle helmets in teenagersódo health
beliefs influence behavior. Arch Dis Child 1994; 71:536-9.
- Mawson AR, Buindo JJ. Contrasting beliefs and actions of drivers regarding
seat belts: A study in New Orleans. J Trauma 1985; 25:433-437.
- McLoughlin E, Vince CJ, Lee AM et al. Project Burn Prevention: outcome
and implications. Am J Pub Health 1982; 72:241-247.
- Van Schagen IN, Brookhuis KA. Training young cyclists to cope with dynamic
traffic situations. Accid Anal Prev 1994; 26:223-30.
Finally, we have also excluded studies in which the outcome has not be clearly
shown to be related to risk of injury. For example, in studies of child abuse,
many reports used parenting skills or the home environment as outcome measures.
These were excluded since the link between changes in these outcomes and risk
of injury form abuse has not been established. In contrast, studies in which
the outcome was seat belt use or bike helmet use were included, because there
are data showing a direct link between changes in these outcomes and changes
in rates of injury.