Forty-two publications, which were not included in the authors' previous reviews (see Other Publications of Related Interest nos.2-3), were identified. Eight of the included studies were randomised controlled trials.
The quality of the evidence was rated as good/reasonable in 12 studies, reasonable in 13 studies and reasonable/weak in 17 studies.
A broad range of health promotion approaches were evaluated in the review and the interventions were targeted at a variety of different levels. A summary of the effective of the different approaches is presented here; a more detailed evaluation of the included studies is presented in the full report.
The Road Environment.
Transport policies and the prevention of injuries (1 study): the authors noted that there was a paucity of studies on the effectiveness of policy level interventions to reduce injuries in the road environment. There was some evidence that school-crossing patrols have reduced road traffic accidents. More evidence in this area is needed.
Traffic calming/area-wide engineering measures (6 studies): there was good evidence that area-wide engineering schemes and traffic calming measures reduced accidents. The studies showed that vulnerable road users (i.e. pedestrians and cyclists) benefited from such schemes. In addition, area-wide engineering schemes were shown to be cost- effective. More research is needed to support the finding that cycle tracks reduce some cycle injuries.
Pedestrian skills training (10 studies): these programmes were shown to improve children's skills, both for individual skills such as timing and finding safe places to cross and a combination of skills, provided that they were specifically targeted. However, no studies have shown that pedestrian skills training has reduced children's injuries.
Pedestrian education (5 studies): school-based traffic club programmes were not shown to be effective. However, children's traffic clubs, using age-paced materials to promote parental teaching, have shown good evidence of behavioural change in parents and children. More evidence is needed to support the finding that children's traffic clubs reduce casualties.
Other traffic education (7 studies): road safety programmes that combined education and environmental measures in an integrated package showed some potential, but more research is required. One study showed that young people (11 to 18 years) were hard to reach and some methods may even be harmful.
Bicycle skills training (3 studies): there was some evidence that bicycle training schemes can improve safe riding behaviour.
Promotion of bicycle helmets (18 studies): bicycle helmet education campaigns were shown to increase the use of helmets. Reducing the cost of helmets appeared to facilitate uptake and use. A number of studies reported more success with younger children and girls.
Bicycle helmet legislation: cycle helmet legislation was associated with injury reduction, though more evidence is needed. Cycle helmet legislation was shown to discourage child and teenage cyclists in a series of studies. Legislation with supporting educational activity was shown to be an effective way of increasing the observed helmet use.
Child restraint loan schemes (9 studies): the loan of car safety seats appeared to be an effective strategy for increasing the numbers of children transported safely in cars.
Educational campaigns to increase child restraint and seat belt use (16 studies): educational approaches appeared to be effective for increasing the number of babies and children restrained in cars. More intensive programmes seemed to be associated with more positive results. The programmes may be less effective in some groups, in particular teenagers.
Child restraint and seat belt legislation (9 studies): legislation requiring the restraint of children in cars was associated with reductions in injury and death. Legislation increased the number of children observed using restraints, although legislation alone may not achieve high levels of restraint use.
Enforcement of legislation (5 studies): police enforcement of car occupant restraint laws has achieved some increases in observed restraint use.
The Home Environment.
Prevention of general home accidents (11 studies): there was little evidence that campaigns to prevent general home accidents led to any reduction in injuries in young children. There was some evidence that such campaigns may lead to environmental and behavioural change.
Other specific home accidents (2 studies): there was limited evidence that campaigns were associated with reductions in injury; more evidence in this area is needed.
Prevention of burns and scalds (16 studies): educational campaigns were partially effective in increasing knowledge of burn and scald prevention. However, there was little evidence that these approaches have achieved reductions in burn and scald injuries. Programmes involving the distribution of smoke alarms seemed to be an effective means of achieving reductions in fire injuries. There was little evidence that campaigns to reduce domestic hot water temperatures were effective.
Burn legislation and regulations (3 studies): improved product design was shown to be effective in reducing specific burn and scald injuries. More evidence is needed of legislation relating to smoke alarms and hot water heaters.
Prevention of poisoning by educational interventions (5 studies): There was evidence to show that interventions to increase the safe storage of non-medicinal poisons may be an effective way to prevent poisoning, but more research is needed. Educational interventions aimed at children and parents were associated with increased knowledge of poison and poison prevention.
Prevention of poisoning by regulations (2 studies): though more research in this area is needed, there was evidence that child restraint packaging may be an effective means of reducing poison injury and death.
Prevention of injuries in the leisure environment (7 studies): more evidence in this area is needed, but interventions to promote safety have been associated with positive results and reductions in the number of injuries. For example, playground hazards have been reduced following school-based interventions.
Mass media and training interventions (5 studies): there was no evidence that general mass media or training events led to a reduction in child injuries. However, these approaches have been shown to increase safety knowledge.
Community-based childhood injury prevention programmes (10 studies): a number of important elements of community-based approaches were identified. These included: a long-term strategy; effective, focused leadership; multi-agency collaboration; the involvement of the local community; appropriate targeting; and the time to develop a range of local networks and programmes. The use of local surveillance systems was shown to be essential to target and evaluate interventions, and to motivate participants.