April 25, 2003

Subcontract with
Ogilvy Public Relations Worldwide on
Contract No. 200-199-00061

SafeUSA Literature Review Project
Executive Summary

Submitted to:
Jennifer Wayman
Senior Vice President
Ogilvy Public Relations Worldwide
1901 L Street, NW, Suite 300
Washington, DC 20036

During the time period September 2002 to April 2003, Aspen Systems Corporation (Aspen) provided literature review support services to Ogilvy Public Relations Worldwide (Ogilvy), on behalf of the Centers for Disease Control and Prevention (CDC) for SafeUSA.

Specifically, Aspen provided research support for literature reviews of research findings that address: (1) public perception of safety interventions and (2) the utilization of interventions. The overall purpose of this project was to provide research evidence and summaries of current public opinion about safety topics that can direct the development of strategies, messages, and materials for injury and violence prevention campaigns.

The focus of the research project was limited to four specific topical areas and one general area. Criteria for topic selection were the magnitude of the problem and the existence of known prevention strategies. Within each broad topical area, specific interventions of focus were selected by the SafeUSA Research and Evaluation Committee in consultation with CDC, who funded this activity.

The following topical literature reviews were conducted:

1. Topic 1 - Motor Vehicle Safety Interventions: occupant safety (child passenger restraints, adult restraints, airbags) and alcohol-related interventions (check-points, .08 legislation)
2. Topic 2 - Home Fire Safety Interventions: smoke alarms, sprinklers, escape plans, smoking interventions (e.g., fire-safe cigarettes)
3. Topic 3 - Youth Violence Interventions: school programs, mentoring programs, social emotional learning, weapons carrying
4. Topic 4 - Family Violence Interventions: mandatory arrest policies, batterers programs, shelter programs, screenings and referrals, child abuse prevention, nurse home visitation, parenting programs

For each topic, two literature reviews were conducted - one focusing on utilization of the safety interventions and one focusing on public perception of the safety interventions. The literature reviews attempted to answer the following two research questions:

1. How effective does the public think that preventive interventions are? For example, how effective does the public think smoke alarms are?
2. How widely utilized are the interventions? For example, how many homes have working fire alarms?

An additional literature review was conducted for a fifth topic - General Safety. This literature review addressed the following set of research questions:

1. Is the public worried about safety?
2. Do people connect physical safety enhancement with other positive outcomes?
3. What are the perceptions that act as barriers and facilitators to practicing safe behavior?
4. What do these words mean to people: injury, accident, and safety?
5. When people think of injury, do they think of unintentional injury and violence separately or together?
6. Do people see accidents as random acts or preventable events?

The project followed the methodological principles of conducting a formal systematic review, which were adapted to the purpose of the project as well as its constraints, including time limits and available resources. These methods included procedures used to search for, identify, classify, and annotate the relevant literature.

Classification Scheme. A classification scheme was developed for each topic to guide the identification and screening of citations. The classification scheme identified the specific interventions and the topical focus of each review.

Selection Criteria. Selection criteria were established to identify potentially relevant literature. Examples of criteria include:

• Conducted in the U.S. and Canada
• Related to the interventions of interest
• Included a focus on either intervention utilization or perception of effectiveness

Search Methods. Two search methods were conducted to identify eligible literature:
(1) searches of electronic databases and (2) search for "grey" literature, through solicitation of materials from SafeUSA partners.

Across the five topics, the electronic resources that were searched included: Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE/PubMed, PsycINFO, Sociological Abstracts, MasterFILE Premier, and the Cochrane Library. Other resources were used for specific topics (e.g., ERIC for youth violence).

The grey literature search consisted primarily of solicitation of relevant materials from the SafeUSA Partners. The Partners represent agencies such as the National Safety Council, the Health Resources and Services Administration - Maternal and Child Health Bureau, and the National Association of Injury Control Research Centers. Each of the partners was sent a formal request for information to support the literature review (via email and surface mail) in January 2003.

Screening, Classification and Annotation. Standardized procedures for reviewing (to screen for relevance), classifying, and annotating citations identified through electronic searching and grey literature search methods were implemented for each literature review. These procedures were followed to obtain the final set of relevant citations for synthesis and inclusion in the Annotated Bibliographies.

Bibliographic Data Management. Citations were stored in Reference Manager (Version 10), the software package used to develop the bibliographies. Annotations were entered directly in Reference Manager. A separate Reference Manager database was created for each topic to support the literature reviews.

Synthesis. For each review, the annotation results were used to perform descriptive syntheses of the data.

Topic 1: Motor Vehicle Safety Interventions

Overall, a total of 148 citations were found to be relevant for the reviews on the perception and/or utilization of motor vehicle safety interventions.

Perception

• A total of 42 citations were found to focus on public perception of the effectiveness of motor vehicle safety interventions.
• Literature indicates that women who use seat belts consider themselves to be positive role models, though they are not likely to try to persuade others to use seat belts because they believe their encouragement will not be well received.
• Reports focusing on child restraints discuss the knowledge, attitudes or perceptions held by parents and caregivers that influence their use of child restraints. Some of the literature suggests that perception of effectiveness alone is insufficient to increase utilization.
• Literature suggests that while the public has some knowledge about proper seating positions, they still hold misperceptions about the protection airbags offer and the high risk of airbags to children.

Utilization

• Overall, a total of 122 citations were found to focus on public utilization of motor vehicle safety interventions.
• Literature on adult restraints profiles seat belt use by gender, race/ethnicity, and vehicle type and discusses seat belt use by pregnant women.
• An important issue in the literature on child restraints is the correct placement of the child and/or seat, because without proper placement the device is not an effective method for improving occupant safety.
• Literature indicates that common features for states that have high utilization rates of sobriety checkpoints includes available funding and citizen activism.

Topic 2: Home Fire Safety Interventions

Overall, a total of 43 citations were found to be relevant for the reviews on the perception and/or utilization of home fire safety interventions.

Perception

• A total of eight citations were found to focus on public perception of the effectiveness of home fire safety interventions.
• Reports focus on the decision making process associated with the selection of home fire safety interventions, particularly smoke alarms and fire sprinklers.
• Literature also focuses on more general perceptions of risk associated with fire and beliefs about the preventablity of fire-related death and injury.

Utilization

• Overall, a total of 37 citations were found to focus on public utilization of a home fire safety intervention.
• Literature on smoke alarms points to the importance of measuring rates of utilization for working smoke alarms, instead of merely the presence of an alarm, as well as differences between utilization rates for different groups.
• Literature focusing on fire escape plans indicate that there may be vastly different rates for having a fire escape plan and actually practicing it.

Topic 3: Youth Violence Interventions

Overall, a total of 68 citations were found to be relevant for the reviews on the perception and/or utilization of youth violence interventions.

Perception

• A total of 30 citations were found to focus on public perception of the effectiveness of youth violence interventions.
• Literature on school-based youth violence programs targeted students in high school or middle school, and youth impressions of program effectiveness.
• Reports on weapons-carrying interventions address a wide range of information including beliefs about gun control, student concerns about penalties for possession of weapons on school property, and enforcement of gun control laws.

Utilization

• Overall, a total of 44 citations were found to focus on public utilization of youth violence interventions.
• Literature on school safety programs provides general overviews of the use of school programs as well as information on program usage by state.
• Literature was also found on utilization of interventions targeting gang violence, dating violence, community based programs, public service announcements, home and family based interventions and interventions delivered in a clinical setting.

Topic 4: Family Violence Interventions

Overall, a total of 168 citations were found to be relevant for the reviews on the perception and/or utilization of family violence interventions.

Perception

• A total of 88 citations were found to focus on public perception of the effectiveness of family violence interventions.
• Literature on mandatory arrest policies provides perception data from a variety of sources, including professionals in the field of domestic abuse and elder abuse and couples currently involved in spouse/partner violence programs.
• Reports focusing on screening and referral programs provide information on the ways the screening and referrals are perceived by different groups, including female patients in emergency departments, victims of spouse/partner violence, mothers of abused children, and abused children themselves.
  
• The majority of the literature on child abuse prevention programs reports positive perceptions of the programs from children, parents, and adolescent parents.
  

Utilization

• Overall, a total of 98 citations were found to focus on public utilization of family violence interventions.
• The largest proportion of citations focuses on screenings and referrals, specifically rates of screening by professionals.
• Literature on child abuse prevention programs includes rates of utilization by the general public and specialized groups such as the military and specific neighborhoods/communities.
• Reports on parenting programs present utilization rates for programs targeting North American Indians, parents of special needs children, as well as within specific geographic regions.

Topic 5: General Safety

Overall, a total of 86 citations were found to be relevant for the review on General Safety. Findings include the following:

· Thirty-four citations addressed the question, "Is the public worried about safety?" and many of the reports pertain to safety worries in a specific context or setting such as safety in school, neighborhoods, and in the home.
· Thirty citations focused on the public's perceptions of specific safety practices, as well as their beliefs about injury prevention, health, fate, and other factors that may either facilitate or inhibit the adoption and use of practices that reduce the risk of injury.
· Nine citations were found to address the question, "What do these words mean to people: injury, accident, and safety?" and the reports focus on terminology, including the impact of using the word injury instead of the word accident and how the public interprets the word accident.
· Fifteen citations related to the question, "Do people see accidents as random acts or preventable events?"; much of this literature focuses on injuries in the home, and often addresses parents' perceptions of whether childhood injuries are preventable.

Overall, this review of the literature for five separate safety intervention topics forms a knowledge base that sets the stage for future research activities including the implementation of focus groups, case studies, and survey research and ultimately, the development of injury prevention media campaigns.

• More in-depth literature reviews could be conducted for specific topics and/or safety interventions. These reviews could involve more intensive search for the grey literature, increased communication with the SafeUSA partners to refine topics, and additional electronic database searching.
• Content experts (e.g., SafeUSA partners or others) could be assigned to specific topics and/or interventions to guide literature review activities such as the development of classification schemes and search methods, selection of relevant material, and interpretation of findings.
• Solicitation of relevant intervention materials from the SafeUSA partners should be continued, as there was only a 22% response rate to Aspen's request for assistance in January 2003. Much of the information received contributed to the literature reviews and additional requests may yield significantly more relevant material.
• An in-depth review of existing survey data addressing public perception and utilization of safety interventions could be conducted. While such an activity was beyond the scope of the current project, once relevant datasets were identified either the full survey results could be obtained or the dataset itself could be acquired for secondary data analysis.