Evaluating the impact of a school-based helmet promotion program on eligible adolescent drivers: different audiences, different needs?

The school environment has been often identified as a prosperous venue for public health improvement. This study is a cluster randomized controlled trial evaluating the impact of a school-based helmet promotion program on knowledge, attitudes and practices of eligible adolescent drivers. Four public, four private and four vocational high schools situated in Attica, Greece, were sorted by type and randomly assigned to receive a 1-month intervention, based on the concepts of the Health Belief Model, or serve as controls. Self-report data were collected at baseline from 741 second grade students (∼16 years) and immediately after program completion. Linear mixed models with random student effects were used to estimate mean changes in scores for each treatment group and corresponding between groups differences of changes. Likelihood-based analysis showed that the intervention yielded a significant improvement in knowledge about helmet use. Yet, its impact on attitudes and practices appeared to vary across different school types. With current research offering ambiguous results on the appropriate timing of injury prevention efforts, this study suggests that educational programs targeting road safety can lead to positive changes if tailored to the needs of specific population groups and implemented during critical life periods, such as the transition to driving status.

Seatbelt use, attitudes, and changes in legislation: an international study.

BACKGROUND: The use of seat belts is among the most effective methods of reducing injury in motor vehicle crashes. We examined trends in seat belt use by university students from 13 European countries between 1990 and 2000, in relation to changes in legislation, attitudes, and hazardous driver behaviors. METHODS: Data were collected via an anonymous standardized questionnaire from university students in Belgium, England, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, the Netherlands, Poland, Portugal, and Spain. There were 10,576 respondents in 1990, and 10,294 in 2000. Data were also collected from 1672 students in the United States in 2000. Analyses were performed in early 2002. RESULTS: Reported seat belt use increased from 63% to 73% in male students, and from 66% to 77% in female students over the decade. There were marked increases in seat belt use in countries with changes in legislation or enforcement from 1990 to 2000, with 24% to 64% more respondents reporting seat belt use in 2000. The prevalence of use and noted changes during this period correlated with findings from national surveys (r= 0.91). Attitudes to seat belt use were associated with behavior both within and between countries. Nonuse of seat belts was positively related to alcohol-impaired driving and failure to obey speed limits. CONCLUSIONS: Legislation has a substantial impact on the use of vehicle seat belts, but additional gains require efforts to change attitudes within the university student population.