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BackgroundInjury prevention interventions are often implemented at the group level via communities, hospitals, schools, etc, making cluster randomisation a suitable approach to evaluation. The stepped-wedge cluster randomised trial (SW-CRT) design has become increasingly popular for evaluating interventions in real-world settings.MethodIn this commentary, we describe the methodological characteristics of the SW-CRT design and highlight key threats to validity, relevant design and analytical issues, and scenarios in which the SW-CRT design might be a reasonable design choice. We illustrate these key points using a recently completed SW-CRT: the prehospital Canadian C-Spine trial.ResultsSeven potential biases associated with SW-CRTs, including: (1) secular trends, (2) confounding by external factors, (3) identification and recruitment bias, (4) contamination, (5) late and early transitioning, (6) risks of baseline imbalances due to small numbers of clusters and (7) statistical issues are discussed, along with potential mitigation strategies.ConclusionThe SW-CRT design offers a pragmatic approach to evaluating injury prevention interventions that may involve a staggered rollout across services or regions. The design allows an intervention to be rolled out to all participating sites and provides an opportunity to efficiently evaluate effectiveness. It is important, however, for researchers to consider the unique design and analytic issues associated with the SW-CRT design. Mitigating potential threats to validity when using the SW-CRT design helps ensure robust evaluation of injury prevention interventions.

To investigate the impact of a road safety programme on adolescents' willingness to engage in risky behaviour as probationary drivers, adjusted for covariates of interest. The streetsmart is a road safety programme delivered to around 25 000 adolescent students annually in New South Wales. Using a smartphone-based app, student and teacher participation incentives, students were surveyed before and after programme attendance. Mixed-methods linear regression analysed pre/post-modified Behaviour of Young Novice Driver (BYNDS_M) scores. 2360 and 1260 students completed pre-event and post-event surveys, respectively. Post-event BYNDS_M scores were around three points lower than pre-event scores (-2.99, 95% CI -3.418 to -2.466), indicating reduced intention to engage in risky driving behaviours. Covariates associated with higher stated intentions of risky driving were exposure to risky driving as a passenger (1.21, 95% CI 0.622 to 2.011) and identifying as non-binary gender (2.48, 95% CI 1.879 to 4.085), adjusting for other predictors. Trauma-informed, reality-based injury prevention programmes can be effective in changing short-term stated intentions to engage in risky driving, among a pre-independent driving student population. The adolescent novice driver age group is historically challenging to engage, and injury prevention action must be multipronged to address the many factors influencing their behaviour.

BackgroundMobile telematics offers a promising new data source for evaluating safety interventions, providing detailed information about driving behaviour and safety events. We examined whether telematics data could effectively evaluate the impact of red-light cameras on driver behaviour and crash risk.MethodsWe analysed mobile telematics data from over 770 000 users in Chicago to assess how the presence of a red-light camera at an intersection approach affected the likelihood of collisions and harsh braking. We matched intersection approaches with and without cameras on the number of lanes, speed limit, traffic volume and segment length. We used negative binomial regression models to evaluate the impact of cameras on collisions and harsh braking by time of day and season.FindingsHarsh braking events occurred 24 times more frequently than collisions and showed remarkably similar patterns of association with environmental factors. Both showed higher frequency during rush hour (11% and 23% increases, respectively), lower at night (73% and 80% decreases) and increasing frequency with more lanes. These effects were consistent across seasons and time of day. Cameras reduced both collisions (25% reduction; 95% CI 15% to 34%) and harsh braking events (21% reduction; 95% CI 12% to 28%).InterpretationTelematics data show effects of cameras that are consistent with past evaluations. Furthermore, there was close correspondence between collision and harsh braking patterns. Together, these suggest that telematics-reported data provide a surrogate measure for road safety and can provide richer information for safety evaluation in settings where crash data are sparse, though the inability to distinguish injury severity remains a limitation.

IntroductionSwimming skills are an evidence-based component of drowning prevention. However, in Australia, many children miss out on learn to swim education. Voucher programmes may reduce swimming lesson cost and increase participation, especially among priority populations. The First Lap voucher programme provides two New South Wales state government-funded $100 vouchers for parents/carers of preschool children to contribute to swimming lesson costs. This evaluation aims to determine the effectiveness of the programme in meeting objectives of increasing preschool-aged children participating in learn to swim programmes and building parent/carer knowledge and awareness of the importance of preschool-aged children learning to swim.Methods and analysisA programme logic model was developed to explain the inputs, activities and intended outputs, and outcomes, which guided this mixed-methods evaluation design of quantitative and qualitative analysis within an impact/outcome evaluation. Baseline sociodemographic registration data will be provided by the parent/carer of each child participant and linked to swim school provider data on voucher redemption. Data will be collected on voucher use, knowledge, and attitudes to swimming lessons at registration and across two surveys. An economic evaluation will assess programme cost-effectiveness.ConclusionThis evaluation will determine impacts on participation rates in learn to swim programmes, particularly within priority populations. It will examine whether the programme has influenced attitudes and motivations of parents and carers toward learn to swim programmes and water safety, whether the programme has impacted or enhanced the ability of the aquatics sector to deliver learn to swim programmes and assess its cost-effectiveness.

BackgroundExplosive remnants of war claim more than three lives every day in Afghanistan. This study evaluates the impact of BBC Media Action Afghanistan’s Explosive Ordnance Risk Education project in raising public awareness and promoting safe behaviours regarding explosive ordnances in Afghanistan. The project deployed a multimedia approach to reach a mass audience, including a radio discussion show, public service announcements on TV and radio, social media content and playing content on intercity buses.MethodsA panel study with 400 participants from high-risk provinces assessed knowledge, discussion and behavioural intentions related to explosives before and after a mass media intervention. In the broadcast period, the research unobtrusively monitored the dosage of exposure to the media content.ResultsFindings from the panel study indicated a significant increase in discussions about explosive risks and safer behavioural interventions (e.g. avoiding and reporting explosive ordnances) post intervention.ConclusionThe results constitute one of the first pieces of systematically collected evidence on media and communication’s potential in explosive risk education by facilitating interpersonal discussion and in turn change of behavioural intentions in areas contaminated by explosive ordnances and remnants of war.

BackgroundCoal mine gas explosion injury has caused mass casualties, which have resulted in widespread concern.MethodsIn order to prevent gas explosion injury in coal mine, 24Model is proposed to analyse the risk in this paper. 24Model is a human-oriented and organisation-oriented risk analysis method. Based on the 24Model, we propose a general procedure for analysing the causes of injury within the organisation.ResultsA coal mine gas explosion case was analysed using the 24Model and the proposed analysis method, and the evolution of injury and the interaction of various causes was showed, and 6 unsafe conditions, 25 unsafe acts, 13 safety knowledge, 13 safety management systems and 13 safety cultures were obtained.ConclusionCase analysis results show that by using the 24Model and analysis method the proposed effect can help employees to clearly see the evolution and identify the causes of the injury, to better understand the logical relationship with the causes of the injury, improve the effectiveness of training and effectively prevent similar injury. The case study provides a practical procedure for injury investigation and analysis, and thus, preventive measures can be made according to the various causations at different levels.

ObjectivesSafeTea is a multifaceted intervention delivered by community practitioners to prevent hot drink scalds to young children and improve parents’ knowledge of appropriate burn first aid. We adapted SafeTea for a national multimedia campaign, and present a mixed-methods process evaluation of the campaign.MethodsWe used social media, a website hosting downloadable materials and media publicity to disseminate key messages to parents/caregivers of young children and professionals working with these families across the UK. The SafeTea campaign was launched on National Burns Awareness Day (NBAD), October 2019, and ran for 3 months. Process evaluation measurements included social media metrics, Google Analytics, and quantitative and qualitative results from a survey of professionals who requested hard copies of the materials via the website.ResultsFindings were summarised under four themes: ‘reach’, ‘engagement’, ‘acceptability’ and ‘impact/behavioural change’. The launch on NBAD generated widespread publicity. The campaign reached a greater number of the target audience than anticipated, with over 400 000 views of the SafeTea educational videos. Parents and professionals engaged with SafeTea and expressed positive opinions of the campaign and materials. SafeTea encouraged parents to consider how to change their behaviours to minimise the risks associated with hot drinks. Reach and engagement steadily declined after the first month due to reduced publicity and social media promotion.ConclusionThe SafeTea campaign was successful in terms of reach and engagement. The launch on NBAD was essential for generating media interest. Future campaigns could be shorter, with more funding for additional social media content and promotion.

BackgroundMāori (the Indigenous population of Aotearoa New Zealand) experience increased burden of unintentional injury and reduced access to publicly funded injury prevention and rehabilitation services, compared with non-Māori. Māori-led models of care have been shown to improve outcomes for Māori. Paeārahi navigate across sectors (including health, education, housing and employment) to advocate for the best possible outcomes for individuals and families. This study aims to (1) test the acceptability and feasibility and (2) undertake exploratory efficacy analysis of a paeārahi injury intervention for Māori older adults.MethodsA prospective non-randomised, non-comparator study with preintervention and postintervention measurements of predefined outcomes. Eligible participants who consented to participate (Māori, 55+ years, community-dwelling and enrolled in one of three study general practices) will undergo a multivisit paeārahi intervention. The intervention includes home-hazard assessment, basic health screening, teaching of strength and balance exercises, education relating to injury prevention and access to injury-related, referral and connection to other health and social services) and participants can choose to have whānau (family) involved in the intervention.OutcomesThe primary outcome of interest is participant, whānau and paeārahi acceptability of the intervention. Secondary outcomes include intervention feasibility, cost-effectiveness and exploratory efficacy (including preintervention and postintervention unintentional injury-related hospitalisation, primary care access and public injury-related claims).DiscussionThe findings of this intervention research will be used to inform injury care models for older Māori and process for Māori-led health intervention development more generally.Trial registration numberACTRN12621001691831p.

BackgroundMexico City approved new road safety policies in 2015, which included lower speed limits and higher fines for traffic offences. In 2019, economic fines were replaced by a point penalty system among other changes. This study evaluates these policies on road traffic collisions, injuries and deaths.MethodsCollisions data came from insurance collision claims (January 2015 to December 2019) and road traffic deaths from vital registrations (January 2013 to December 2019). We conducted an interrupted time series analysis for each outcome using negative binomial regression models with an offset of insured vehicles (collisions) or total population (deaths). Then, we classified the 16 municipalities in the city into enforcement and no-enforcement groups based on presence or absence of automated traffic enforcement devices and conducted a controlled interrupted time series analysis.ResultsThe 2015 road safety policies had no effect on total collisions and collisions resulting in injury but were associated with a 0.2% (95% CI −0.3 to 0.0) decline in the mortality trend. The 2019 policies had no effect on total collisions but were associated with a 1.5% increase in the trend of collisions resulting in injuries and with a 2.7% (95% CI 1.0 to 4.5) increase in the mortality trend. Postpolicy trends in enforcement versus no-enforcement municipalities were not significantly different.ConclusionPolicies that included high economic penalties for speeding and dangerous behaviours were effective in decreasing traffic mortality while removing economic penalties and replacing them with a point penalty system were associated with an increase in collisions, resulting in injury and mortality.

ObjectiveTo investigate the impact of a road safety programme on adolescents’ willingness to engage in risky behaviour as probationary drivers, adjusted for covariates of interest.MethodThe bstreetsmart is a road safety programme delivered to around 25 000 adolescent students annually in New South Wales. Using a smartphone-based app, student and teacher participation incentives, students were surveyed before and after programme attendance. Mixed-methods linear regression analysed pre/post-modified Behaviour of Young Novice Driver (BYNDS_M) scores.Results2360 and 1260 students completed pre-event and post-event surveys, respectively. Post-event BYNDS_M scores were around three points lower than pre-event scores (−2.99, 95% CI −3.418 to −2.466), indicating reduced intention to engage in risky driving behaviours. Covariates associated with higher stated intentions of risky driving were exposure to risky driving as a passenger (1.21, 95% CI 0.622 to 2.011) and identifying as non-binary gender (2.48, 95% CI 1.879 to 4.085), adjusting for other predictors.ConclusionsTrauma-informed, reality-based injury prevention programmes can be effective in changing short-term stated intentions to engage in risky driving, among a pre-independent driving student population. The adolescent novice driver age group is historically challenging to engage, and injury prevention action must be multipronged to address the many factors influencing their behaviour.