Susan ayers cambridge handbook of psychology he

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intervention. While behaviour is undeniably an important factor
in injury causation, the Haddon Matrix demonstrates that it is
only one of several areas where intervention may be effective.
In determining the appropriate intervention, it is important to
recognize that injury prevention is not necessarily based upon the
most obvious cause of contributing factors. Interventions may occur
at a number of points in the chain of events that can lead to injury
(Williams & Lund, 1992). Adoption of an energy control strategy
to injury prevention led to discarding the term ‘accident’. The
connotation of chance, fate and unexpectedness has been replaced
by descriptions of injuries and physical and chemical injuries
involved (Williams & Lund, 1992).
Psychological factors and injury control
Human behaviour remains an important factor in injury control. This
view has been reinforced in recent years as psychologists and others
have begun to contribute to our understanding of the behavioural
and social causes. Within the field of injury prevention, a dialectic has
developed between proponents of individually directed interventions
and those who support public health models (Frank et aI., 1992).
These approaches to prevention have been characterized as active
versus passive or individual versus population. Active individual
injury prevention requires action by the individual to reduce risk
(e.g. wearing a seat belt, using a motorcycle helmet, exercising or
maintaining proper diet). Active or individual approaches reflect
the legacy of health psychology, with its emphasis upon individuals
assuming responsibility for their own behaviour (Frank et al., 1992).
The passive intervention model, derived from public health
approaches, emphasizes altering health behaviours at the population
level (Frank et al., 1992). In this approach, intervention is
designed to automatically affect all individuals. Passive intervention
models are viewed as most effective because they avoid difficulties
associated with individuals making consecutive decisions regarding
health and safety behaviours. Examples of the passive or population
approach include automatic seat belts, mandatory air bags, locking
systems to prevent drunken driving and air safety restraints.
Most often, active and passive approaches have been viewed as
mutually exclusive. Others have suggested that active and passive
approaches to injury reflect a continuum (Frank et al., 1992). Models
of health psychology have included a broader emphasis upon the
health of communities (Winett et al., 1989). Roberts (1987) has
suggested that a multilevel approach is the most effective approach
to injury control. In this approach, the active individual model congruent
with health psychology is viewed as one end of a continuum,
while the passive approach that matches public health models
anchors the other end of the continuum.
Recently, a health promotion approach has been recognized as
useful to injury prevention (Sleet et al., 2004). Health promotion,
by definition, involves targeting behaviours, environments and policies
in the prevention of injury (see ‘Health promotion’). The immediate
goals of health promotion strategies with regard to injury
prevention are to reduce individual risk factors, minimize exposure
to hazards in the environment and remove unsafe products. These
goals are achieved by individual and community efforts through
education, social and organizational change, and public policy,
legislation and enforcement (Sleet et al., 2004).
In the area of health education, the PRECEDE model (Predisposing,
Reinforcing, and Enabling Causes in Educational Diagnosis
and Evaluation) was developed for planning education programmes
(Fee et al., 2000). In this model, prevention strategies are dictated by
three sets of factors: predisposing factors (individual characteristics),
enabling factors (aspects of the environment) and reinforcing
factors (rewards or punishment of behaviour). Once prevention
strategies are implemented, evaluation of the prescribed programme
is an integral part of the PRECEDE model (Fee et al., 2000).
Although many opportunities exist for psychologists to be
involved in the community approach to prevention of injury, the
traditional niche occupied by health psychologists with its emphasis
upon the individual has most often been the focus of the profession.
Because injury most often affects individuals under the age of 24,
a disproportionate emphasis has been placed upon injury
prevention among children and adolescents.
The prevention of childhood injuries continues to be a major
research area (Peterson & Roberts, 1992). It is now clear that the
parents whose children are most at risk (poor, under-educated,
disturbed, or from single parent families) are least likely to utilize
safety precautions. Children most at risk are preschoolers older than
2.5 years and children who display difficult behaviours are at higher
risk than other children (Dal Santo et al., 2004). Many parents do
not appreciate, or are indifferent to, factors that may contribute to
injury. Often, even middle-class parents lack a strong sense of
risk factors for their children. Children are rarely taught safety
behaviours (Peterson & Roberts, 1992). Too often, injury prevention
is based upon single presentations of safety material in classrooms.
Peterson and Roberts (1992) observed that educators would never
consider teaching maths by working arithmetic problems before
children for one hour, or teaching spelling by having the teacher
discuss spelling. These methods often serve as a safety curriculum
in schools. Parents greatly over-estimate their children’s safety
knowledge, and when asked where the child acquired these
presumed skills, parents most frequently cite visits of police or fire
officials to the class (Peterson & Roberts, 1992).
Injury prevention in children includes a wide variety of interventions.
Injury prevention methods have been classified according to
level: national and state level, community level, family level, caregiver
and child level initiatives (Damashek & Peterson, 2002). As has
been the case with adult and adolescent populations, the two predominant
methods have been legislation and education. Legislative
changes have often been directed at product manufacturers. In
contrast, educational efforts are most often directed at children’s
caregivers and may be direct, utilizing weak contingencies (such
as suggestion that a low probability negative event may be
prevented) or immediate rewards (such as a lottery ticket or prize
to a child). In general, the stronger the contingency, the more
effective the intervention (Peterson & Roberts, 1992).
The most frequently cited legislative success, aimed directly at
the injury vector, was a 1973 mandate requiring child-resistant
packaging and limiting the amount of a drug contained in any one
package (Peterson & Roberts, 1992). Although legislation can be very
successful, the large number of products known to cause injury
to children are inadequately controlled for a variety of reasons.
Many known hazards to children, such as guns, have political
connotations making legislation problematic in some countries.
In other cases, items directly marketed to children are hazardous,