Research Papers

A Review of Study Designs in Childhood Transportation Injury Prevention Research in the Published Literature

Version 1
Date added June 18, 2019
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Category 2019 CARSP XXIX Calgary
Tags Research and Evaluation, Session 3C
Author/Auteur Rothman, Clemens, Macarthur
Stream/Volet Research and Evaluation

Slidedeck Presentation Only:

3C_Rothman_Review of Study Designs


Background/Context: Injury prevention research draws from many professional disciplines, with papers on the prevention of injury published in hundreds of different journals. There are specific methodological challenges in injury research which include, for example, selecting the most appropriate denominator and, adjusting for exposure to injury risk. In this context, there have been calls for injury prevention research to incorporate methodologically rigorous study designs.

Aims/Objectives: The primary objective of this study was to examine the range of research designs used in recently published work related to injury prevention and specifically, child transportation injuries. A secondary objective was to examine the distribution of transportation injuries by study design, prevention approach (education, engineering, and enforcement), and country of origin.

Methods/Targets: Hand searches of pertinent journals over the 4-year period 2013-2016 were done to identify empirical, English language, unintentional injury prevention studies in children <19 years. A previously published framework that stratified journals by the average number of injury prevention papers published/year was used to identify and randomly select 10 journals from each stratum to provide a representative sample. Studies were coded by study design, injury type, primary outcome, and type of prevention approach (education, engineering or enforcement)

Results/Activities: There were 380 studies child injury prevention studies identified, with the majority of studies related to transportation (221, 58%). Most of the transportation studies examined motor vehicle occupants (86, 39%), followed by youth motor vehicle drivers (53, 24%), pedestrians (31, 14%) and cyclists (21, 10%). Of the transportation studies, 96 (43%) were observational (ie ecological/correlational, cross-sectional, cohort, case-control, case-crossover), 68 (31%) were descriptive, 48 (22%) were experimental (including natural experiments), 6 (3%) were qualitative and 3 (1%) had mixed methods. There were only 10 (5%) RCTS. The majority of the experimental studies (26, 54%) evaluated educational interventions alone. The majority of studies (197, 89%) were conducted in high-income countries. Of the 24 LMIC studies, the largest proportion was from the Western Pacific region (China, Malaysia, Cambodia and Laos, 11, 46%), followed by the Eastern Mediterranean region (Iran, 5, 21%), then two each from Europe and Africa, and one from the Americas.

Discussion/Deliverables: Recent child transportation injury prevention research is generally observational or descriptive. Transportation studies predominated in unintentional childhood injury experimental studies, where the injury prevention field overlaps with engineering. Nonetheless, less than ¼ of transportation studies were experimental, and more than half of these evaluated educational interventions alone, despite evidence that this is relatively ineffective in reducing injury burden compared to engineering and legislative interventions.

Conclusions: More rigorous study designs are needed, focusing on engineering and enforcement to effectively reduce the population burden of childhood transportation injury. There is also a need to support and promote injury prevention research in LMICs where the child and youth injury burden is highest.