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Reducing the Burden of Injury: Advancing Prevention and Treatment
social, and political considerations; and likely acceptance by the target population. Through this predevelopment analysis, proposed interventions can be categorized and prioritized according to their potential impact. Those interventions with the greatest potential can be targeted for further development and pilot-tested for identification of unexpected consequences and efficacy. What follows is a summary of recent developments, including a few key research areas that appear to be ripe for further advances.
Behavioral research has demonstrated that many injury interventions require changes in human behavior, either to reduce the exposure or vulnerability of potential victims to injury-causing events or to reduce the risk that one person will become the agent or instrument of harm to another. Behavior change can be achieved by incentives and deterrence, education, and persuasion. Research has shown that beneficial behavioral changes rarely occur through education or persuasion alone. Some of the factors that influence the success or failure of education programs are known (including education levels, timing of educational approaches, e.g., child safety information for expectant parents), but focused research on the specification of these factors is needed. As research continues to increase our knowledge of efficacious strategies, promotion of these strategies has to be emphasized.
Incentives and deterrence. One of the most significant developments in the injury prevention field over the past two decades has been to include the fruits of behavioral and criminologic research in developing behavioral incentives and disincentives, including threats of legal sanctions (deterrence) (Bonnie, 1986). Incentives are often financial. In the consumer arena, discounts in homeowner and automobile insurance premiums can be used as incentives to promote precautionary behavior, such as installing smoke detectors or purchasing cars with airbags, respectively. In the occupational arena, discounts in workers' compensation premiums are being used as incentives for promoting safe work practices.
Deterrence through criminal punishment has been the backbone of the nation's policy for reducing assaultive behavior, and there is a growing body of literature on the preventive effects of criminal sanctions in general and of specific statutory provisions, such as mandatory jail terms for using a weapon in criminal activity (McDowall et al., 1992). Two of the most thorough investigations of deterrence have been in the area of highway safety. Over the past 20 years, a large body of research has been developed on the differential impact of various punishment schemes for drunk driving, including mandatory jail terms and administrative license suspension (Jacobs, 1989; Ross, 1993). More recently, a significant body of knowledge has emerged on the efficacy of laws mandating child restraint and safety belt use, demonstrating that enactment of