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Reducing the Burden of Injury: Advancing Prevention and Treatment
example is the excise tax on alcohol, which is largely considered as a means to raise public revenues. In recent years, studies have demonstrated that raising the alcohol excise tax reduces the highway fatality rate and the rate of violent crime (Cook and Moore, 1993). Policies to increase alcohol excise taxes deserve to be viewed in terms of both revenue enhancement and injury prevention.
Studies of recent safety interventions have highlighted the possibility of modifying social norms and expectations about safety. Changes in attitudes toward alcohol-impaired driving have been associated with changes in driver behavior and with consequent reductions in injury rates. Increased parental use of child occupant restraints as well as increased rates of safety belt use among motor vehicle drivers and passengers has also called attention to the "declarative" role played by legal norms in reinforcing, stimulating, accelerating, or symbolizing changes in public attitudes or expectations about socially desirable behavior (Wagenaar and Webster, 1986; CDC, 1991). One of the interesting challenges faced by researchers investigating the effects of legal prohibitions or requirements is to distinguish between behavioral effects attributable to classical deterrence (behavior modified in response to threatened sanctions) and those attributable to the "declarative" effects of the law, which affect behavior indirectly by changing attitudes (Bonnie, 1986). Further attention to this issue will help policy makers design the most promising ways of deploying legal changes together with educational messages to promote safe behavior, such as safe storage of firearms and other dangerous articles.
Broadening the Scope of Prevention Research
Once an injury problem is identified through surveillance or other means, research is brought to bear to identify causes, circumstances, and risk factors, as well as to develop and evaluate interventions. Evaluating interventions encompasses assessments of feasibility, efficacy, effectiveness, and cost-effectiveness. Outcome measures include changes in attitudes, knowledge, behavior, mortality, morbidity and disability reduction, and economic cost.
Prevention research is accomplished through a burgeoning variety of disciplines. Disciplines at the core of injury prevention research—epidemiology, behavioral science, biomedicine, and biomechanics—continue to be critical to the advancement of the field. Other disciplines are playing increasingly important roles, including economics, criminology, sociology, engineering, law, and molecular biology. As the scope of injury prevention is broadened to incorporate concepts and methodologies from many diverse fields, there is the potential for the development and testing of a far-reaching variety of new and better interventions and a fuller, multipronged approach to reducing the incidence and consequences of injury. For example, in the aviation industry, a broad array of inter-