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Introduction:Asymmetric warfare and the reaction to its threats have implications in the way far-forward medical assistance is provided in such settings. Investments in far-forward emergency resuscitation and stabilization can contribute to saving lives and increase the resilience of health systems. Thus, it is proposed to extend the use of the Haddon Matrix to determine a set of strategies to better understand and prioritize activities to prepare for and set-up frontline care in the form of Trauma Stabilization Points (TSPs).Methods:An expert consensus methodology was used to achieve the research aim. A small subject matter experts’ group was convened to create and validate the content of the Haddon Matrix.Results:The result of the expert group consultations presented an overview of TSP Preparedness and Operational Readiness activities within a Haddon Matrix framework. Main strategies to be adopted within the cycle from pre- to post-event had been identified and presented considering the identified opportunities in the context of the possibility of implementation. Of particular importance was the revision of a curriculum that fits the civilian medical system and facilitates its adaptation to the context and available resources.Conclusion:The new framework to enhance frontline care preparedness and response using the Haddon Matrix facilitated the identification of a set of strategies to support frontline health care workers in a more efficient manner. Since the existing approach and tools are insufficient for modern warfare, additional research is needed.

COVID‐19 has exacted a disproportionate toll on the health of persons living in nursing homes. Healthcare providers and other decision‐makers in those settings must refer to multiple evolving sources of guidance to coordinate care delivery in such a way as to minimize the introduction and spread of the causal virus, SARS‐CoV‐2. It is essential that guidance be presented in an accessible and usable format to facilitate its translation into evidence‐based best practice. In this article, we propose the Haddon matrix as a tool well‐suited to this task. The Haddon matrix is a conceptual model that organizes influencing factors into pre‐event, event, and post‐event phases, and into host, agent, and environment domains akin to the components of the epidemiologic triad. The Haddon matrix has previously been applied to topics relevant to the care of older persons, such as fall prevention, as well as to pandemic planning and response. Presented here is a novel application of the Haddon matrix to pandemic response in nursing homes, with practical applications for nursing home decision‐makers in their efforts to prevent and contain COVID‐19.

Many speech-language pathologists (SLPs) recently adopted a live, synchronous online distribution of clinical services due to physical distancing measures aimed at bringing the coronavirus disease 2019 (COVID-19) outbreak under control. Few SLPs had received training in telepractice to prepare them for changes from an in-person service delivery model to synchronous telepractice. The new telepractice environment may alter vocal behaviors and communication interactions in such a way that negatively impacts voice production. Thus, delivering synchronous online clinical services may require that SLPs adopt novel prevention strategies for avoiding phonogenic voice problems. Guided by two complementary injury frameworks, the Haddon Matrix and the Haddon Countermeasures, this article provides an overview of potential factors associated with phonogenic voice problems among SLPs in telepractice and proposes possible prevention strategies to maintain optimal vocal health and function with synchronous modes of online clinical practice.

The aim of this study is to establish an effective early intervention mechanism for construction engineering to prevent electrocution while improving labor safety and reducing the casualty risk. This study used narrative text analysis and the Haddon Matrix for data collection, and analyzed the causes from the 113 electrocution deaths among in the construction industry, the exhaustive chi-square automatic interaction detector algorithm was employed the segmentation of the correlations. Based on the theory of inventive problem solving, through IDEF0 (ICAM DEFinition) for function modeling was designed the early intervention mechanism. This study revealed the operating features related to electric shock hazards. Early intervention was introduced to reduce the relevant risks and establish safety mechanisms. The first contribution of this study is the determination of hazard correlations between operating features and conductive media, and entry point for the prevention of electrocutions. The second contribution is the suggestion of the establishment of inspection stations for electric tools, thereby ensuring that the portable power tools are safe. The final contribution is the joint application of TRIZ (Teoriya Resheniya Izobreatatelskikh Zadatch) and IDEF0, which establishing the pre-entry testing, strengthening safety mechanisms.

IntroductionInjury is a major public health issue in the USA. In 2017, unintentional injury was the leading cause of death for ages 1 through 44. Unfortunately, there is evidence that the sciences of injury prevention and control may not fully and widely integrated into medical school curriculum. This paper describes a novel injury prevention and control summer programme that was implemented in 2002 and is ongoing.MethodsThe main component of the Series includes at least seven injury-related lectures and discussions designed to provoke students’ interest and understanding of injury as a biopsychosocial disease. These lectures are organised in a seminar fashion and are 2–4 hours in duration. Kirkpatrick’s four-part model guides evaluation specific to our four programme objectives. Trainee satisfaction with the programme, knowledge and outcome (specific to career goals) is evaluated using several mixed-methods tools.ResultsA total of 318 students have participated in the Series. Evaluation findings show an increase in knowledge of injury-related concepts as well as an increase in interest in pursuing injury-related research topics in the future.ImplicationsThe Series is a novel and innovative programme that provides training in injury and injury prevention and control-related topics to medical students, as well as undergraduate, graduate and pharmacy students. We hope that by increasing students’ knowledge and understanding of injury prevention and control we are contributing to a physician workforce that understands the importance of a public health approach to injury prevention, that implements public health principles in practice and that advocates for policies and practices that positively impact injury prevention and control to help make our communities healthier and safer.

Since its 1960s origins, the Haddon matrix has served as a tool to understand and prevent diverse mechanisms of injuries and promote safety. Potential remains for broadened application and innovation of the matrix for disaster preparedness. Hospital functionality and efficiency are particularly important components of community vulnerability in developed and developing nations alike. Given the Haddon matrixʼs user-friendly approach to integrating current engineering concepts, behavioral sciences, and policy dimensions, we seek to apply it in the context of hospital earthquake preparedness and response. The matrixʼs framework lends itself to interdisciplinary planning and collaboration between social and physical sciences, paving the way for a systems-oriented reduction in vulnerabilities. Here, using an associative approach to integrate seemingly disparate social and physical science disciplines yields innovative insights about hospital disaster preparedness for earthquakes. We illustrate detailed examples of pre-event, event, and post-event engineering, behavioral science, and policy factors that hospital planners should evaluate given the complex nature, rapid onset, and broad variation in impact and outcomes of earthquakes. This novel contextual examination of the Haddon matrix can enhance critical infrastructure disaster preparedness across the epidemiologic triad, by integrating essential principles of behavioral sciences, policy, law, and engineering to earthquake preparedness.

Workplace violence (WPV) is an ongoing problem in health care. Most of the cases of WPV are caused by the patients, patients’ families, and friends. Violence in hospitals among registered nurses has led to 56% of lost time injuries, and in 2018, Ontario’s Workplace Safety and Insurance Board (WSIB) reported 13% of lost time injuries due to WPV. The Public Services Health and Safety Association (PSHSA) created the Violence Assessment Tool [VAT] to predict the possible risk of violence from patients in acute care settings. Health care workers can use the VAT to assess risk, apply possible control measures and improve their safety. As part of a larger study, the aim of this research is to explore nurses’ perceptions of the utilization of the VAT in assessing the potential risk of violence, and to identify any gaps, challenges, or improvements needed in the VAT. An Interpretive Description research design by Sally Thorne in (2016) will be used. The model that will guide this study is the Haddon Matrix framework of workplace violence prevention. The study will involve three focus groups via zoom virtual meetings with 6 to 8 participants per session, and an expected total of 18-24 participants. Focus group interviews will use semi-structured questions to guide the discussion among nurses working in a Northeastern Ontario hospital. Interpretive description data analysis will be guided by Thorne’s processes of data analysis. This will be the first study to examine nurses’ perceptions of the VAT in Ontario. The findings of this study will help to determine the predictive validity of the VAT and any potential changes that may be needed. The findings of this study could lead to reduced violence and associated costs within the healthcare sector.

Injuries are the leading cause of death for American children, killing over 11,000 children in 2017. They are also a rapidly increasing public health challenge globally: The World Health Organization ranks injury as the leading cause of death globally for children Ages 5 to 18 years, and the Global Burden of Diseases project estimates over 2 million children Ages 0 to 19 years died from injuries worldwide in 2017. Unintentional injuries, sometimes referred to as "accidents" by the lay public, are generally preventable, and psychological science has much to offer in societal efforts to develop, evaluate, implement, and disseminate effective prevention strategies. I first discuss the multifaceted causes of child injuries, which can be conceptualized using classic psychological theory, such as Bronfenbrenner's ecological theory, or classic injury prevention theory, such as the Haddon Matrix. In either case, behavioral risks stem from the child's developmentally influenced decisions and behaviors; the child's family, social, and physical contexts; and the child's broader cultural environments. Risks can also be conceptualized temporally, through behavioral analysis such as antecedents, behaviors, and consequences of the injury. I then present examples of behaviorally focused interventions that target the child, the adult supervisor, and the environment. In each case, I consider psychological risk factors present and the theory-based strategies that might interrupt or alter risk pathways to prevent injury events. I close with comments on the scope of injury as a global public health challenge and the central role psychologists can and should play to reduce the burden of child injury on the world's population. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Emergency Departments (ED) have been identified as high-risk areas for patient related violence (PRV). The aim of the present study was to analyse recorded events of violence in a regional Victorian hospital ED, and examine the association these events had with substance abuse.A retrospective cohort study was undertaken to establish the incidence of PRV. Data were obtained from the hospital's incident management system, RiskMan, over a five and a half year period for all violent events categorised as Code Grey (CG) and Code Black (CB). The Haddon Matrix attached to the individual incident record was also reviewed.A total of 548 violent events were analysed. The incident rate was 3.4 per 1000 ED presentations. Intoxication was the primary reason for violent escalations. There was no association between the frequency of CG events and the day of the week, month of admission, or shift of the day. Intoxicated men (110, 64.3%) were more likely to be the instigator of a violent event compared with intoxicated females (61, 35.7%) (OR 1.5, 95% CI: 1.19-2.02, p0.001). A form of restraint, chemical, physical or both, was used in the majority of violent events (376, 68.6%).This study demonstrated an increasing frequency of violent events in the regional ED. Rates of PRV were comparable to those reported in metropolitan hospitals. Intoxication was the most frequently observed underlying factor for PRV. Regional hospitals are in need of additional resources to instigate policies and procedures that will maximise patient and staff safety.

Despite its industry’s importance and its impact on its community, commercial fishing did not receive much attention from the researchers. Little is understood about accident causations and safety issues among fishermen and their vessels. The paper’ objective was to develop a conceptual framework based on accident analysis models and safety issues, adapted to commercial fishing activities. In this paper, Haddon matrix was used to conceptualize a “man overboard” accident which represents the primary cause of death among marine fisheries’ workers in Canada. This reflective paper attempts to address the complex context of safety issues in the commercial fishing industry by providing a conceptual framework. This study highlights the need of a better understanding of accidental events and safety issues, hence also encouraging fellow researchers to investigate and explore further into health and safety domains.

All-terrain vehicle (ATV) crashes are one of the leading causes of death and injury in agriculture across the United States. Use of ATVs is highly prevalent in rural areas and has seen an increase in their application for a variety of agricultural work tasks. Empirical research on the use of these vehicles for agricultural tasks and associated injuries is limited, especially in the United States. Moreover, little is known about the risk factors associated with ATV-related injuries while doing farm work. A comprehensive review was conducted to evaluate the current injury burden of ATV use in agriculture, the need for future research, and possible solutions related to agricultural ATV safety. Potential injury prevention approaches are evaluated based on the hierarchy of control, including elimination or substitution (using side-by-side vehicles instead of ATVs or modifying ATV design), engineering control (operator protection devices), administrative authority (regulations and standards in the United States and around the world), training, and use of personal protective equipment. In addition, vehicle nomenclature, risk factors, and crash mechanisms are reviewed. Recommendations to decrease the likelihood of ATV crashes and injuries are provided.

Background: Unintentional injuries from burns comprise a significant proportion of public health morbidity in Nigeria. In order to understand the type and impact of burns on youth in Low-and-Middle-Income countries, the epidemiology of burns must be adequately assessed. Methods: This review describes the epidemiological patterns of burn occurrences in the pediatric populations and pro- poses interventions using the Haddon Matrix to address injuries in specific populations in Nigeria. A literature search was conducted using the Proquest, CINAHL, and PubMed databases at the Johns Hopkins University library (January 1, 1990 to August 14, 2018), on burns or thermal injury among pediatric populations in Nigeria. The review focused on the forms of injury, risk factors and potential interventions. Results: Ten studies were identified and the main risk factors for burns were socioeconomic status, overcrowding, and involving young girls in traditional cooking roles. The main types of injuries include scald injuries (50%) and fire burns (45%) affecting mainly children aged 14 and below with significant regional epidemiological variations. We created a novel intervention to develop countermeasures and reduce the number of pediatric burns based on biological, physical and soci- ocultural environment. Conclusion: Interventions such as improved supervision of children, improved emergency infrastructure and culturally sensitive first aid education and treatment can help ensure a reduction in morbidity and mortality resulting from burns. Epidemiological studies can provide an accurate depiction of the burden of burn injuries in different regions of Nigeria. Keywords: Burns; unintentional injury; flame injuries; interventions; injury prevention; epidemiology.

This article is protected by copyright. All rights reserved. Novel coronavirus disease 2019 (COVID-19) pandemic is a public health emergency with several million worldwide and a quarter of a million and soon half a million deaths including a third in the United States alone (as of May 10, 2020).1 It affects kidney transplantation and has caused mortality in waitlist dialysis and transplant patients.2,3 This inevitably raises questions about the practicality and direction of transplant surgeries during this critical period.

Injuries are the leading cause of death and disability in children 1-18 years old in the United States, and many of these injuries are preventable. The Haddon matrix is a foundational concept of injury prevention, examining different phases and factors of the injury process to develop interventions. Primary prevention, including injury prevention, is the first phase of the Emergency Medical Services for Children continuum of care. As part of this continuum, the National Highway Transportation Safety Administration and the Centers for Disease Control and Prevention are integral components of the national prevention efforts to decrease unintentional injuries due to motor vehicle crashes and home and recreational injuries as well as intentional injuries. This article describes a brief history of the Emergency Medical Services for Children, National Highway Transportation Safety Administration, and the Centers for Disease Control and Prevention, as well as injury prevention initiatives for some of the leading causes of pediatric injuries and child maltreatment.

Self-driving or highly automated vehicle (HAV) technologies, now undergoing public trials in major cities,1 are positioned to bring about transformative change to the entire transportation system. Far from being a distant innovation, retail autonomous vehicles have already been announced by various manufacturers for release as early as 2018, complementing estimates that on-road HAVs will reach market ubiquity as part of a US$7 trillion passenger economy by 2055.2 Transportation planners and policymakers are welcoming HAVs for their potential to positively impact traffic safety by fundamentally changing the interaction and relationship between drivers and vehicles, and how drivers and vehicles collect and process information from their environment. HAVs will not, however, offer safety in every possible condition. As HAV technology will have limits, manufacturers and lawmakers suggest vehicles have an operational design domain (ODD) which specifies under which conditions an autonomous driving mode can perform safely.3 ODDs may require HAVs to avoid mixed vehicle routes, inclement weather conditions or unmarked roads; in general, ODDs reflect the limits of HAV technologies. In engineering terms, these are known as ‘edge conditions’: situations that go beyond the reliable and accurate capability and limits of HAV technology. The injury prevention community must understand how these edge conditions could lead to crashes in order to formulate crash countermeasures which ultimately inform vehicle development standards and training. The Haddon Matrix, the long-established safety paradigm for injury prevention, has a rich history of helping those focused on transportation safety explicitly separate roles and responsibilities of all drivers, technologies and environmental factors involved in a crash event.4 A new framework and modification of the Haddon Matrix is needed as man–machine–environment interactions will be facilitated by technology and roles in preventing a crash event will be much more shared. While one could argue that the Haddon Matrix was …

Objective: According to the European Union, fatal road accidents involving Vulnerable Road Users (VRUs) are equal in proportion to fatal car road accidents (46%). VRUs include individuals with mobility challenges such as the elderly and Powered Wheelchair (PWC) users. The aim of this interdisciplinary qualitative study was to identify obstacles and risks for PWC users by exploring their behaviour and experiences in traffic environments. Methods: Videos and in-depth interviews with 13 PWC users aged 20–66 were analysed for this study. The interviews and videos, which include real-life outdoor observations, originate from a qualitative study exploring experiences of PWC use on a daily basis in Sweden. Underlying causal factors to identified risks and obstacles were identified, based on human, vehicle (PWC) and environmental factors in accordance with the Haddon Matrix. Results: The results show significant potential for improvement within all three perspectives of the Haddon Matrix used in the analysis. Participants faced and dealt with various obstacles and risks in order to reach their destination. For example, this includes uneven surfaces, differences in ground levels, steep slopes, as well as interactions with other road users and the influence of weather conditions, resulting in PWC users constantly accommodating and coping with the shortcomings of the vehicle and the environment. Conclusions: There are still major challenges with regard to preventing obstacles and risks in the traffic environment for PWC users. To discern PWC users in traffic accident and injury data bases, a start would be to register type of aid used for persons involved in an accident. Furthermore, to emphasise PWC users’ role as VRUs, it may also be advantageous to describe them as drivers rather than users when navigating the traffic environment. Given the limited sample, further research covering more data from a broader perspective would be beneficial. By incorporating emerging knowledge of PWC users’ prerequisites and needs, and including them in research and traffic planning, the society will grow safer and more inclusive, and become better prepared for meeting future demands on accessibility from an aging population.

Purpose The purpose of this paper is to propose a novel evidence-based Haddon matrix that identifies intervention options for organizations and governments responding to an epidemic in a developing economy. Design/methodology/approach A literature review of articles published within a year of the cholera outbreak in Haiti. Two separate types of literature sources are used – academic and non-academic – to apprehend the value and role of interventions implemented and/or identified. Findings The Haddon matrix helps break down the challenges involved in the containment of an epidemic into smaller, manageable components. This research shows that the matrix enables visualization of past evidence, help dissect various informational sources, and increase collaboration across humanitarian organizations. It will also serve as a building block for academics to identify new research directions to respond to epidemic outbreaks. Research limitations/implications The analysis focuses on the cholera epidemic in Haiti. Future work will be directed to generalize the identified recommendations and insights to a broader context. Originality/value This paper presents an evidence-based Haddon matrix that infers recommendations and insights based on past evidence for each phase (pre-event, response, and post-event) and factor (agent, host, physical environment, and socio-cultural environment) of an epidemic and for various stakeholders (humanitarian organizations, governments, and academics). The matrix provides a structured framework to identify interventions and best practices to address challenges during an epidemic outbreak.

Outdoor recreation in wild areas has many benefits, but also poses risks. We conducted a systematic review of the prevention recommendations in peer-reviewed articles about hiking incidents (injury, illness, or need for rescue) published between 1970 and 2015. Searches in PubMed, Web of Science, and Engineering Village yielded 91 articles after screening for relevance. A total of 559 prevention recommendations were extracted from articles. The foci of the recommendations were categorized using a systems-oriented approach to accident prevention, an adapted Haddon matrix. Five non-mutually exclusive categories were used: hiker, groups and relationships, agent inducing the incident, institutions and sociocultural practices, and equipment. We also coded prevention recommendations that pertained to education within each of the five categories. Sixty percent of the prevention recommendations focused on changing the hiker's decisions and behaviors, and 39% referred to institutions and sociocultural practices. Few addressed the social influences of groups and relationships (8%), equipment (16%), or the agent of harm (16%). Education was the focus of 27% of the recommendations. We conclude that effective prevention needs to include multiple aspects of outdoor recreation systems and their interactions with the hiker's behavior and characteristics. Management implications This systematic review introduces outdoor recreation managers to the systems-oriented Haddon matrix framework for accident prevention in outdoor recreation. By using this framework, this paper: 1. Views accidents as resulting from interactions of individuals with both social and physical environments. 2. Highlights areas for prevention that tend to be missing from published safety recommendations (groups, agent of harm, and equipment). 3. Gives examples of how managers can look at outdoor risk prevention from a broader perspective in order to find innovative solutions to common accidents and rule violations.

Road traffic injuries are placing an increasing and disproportionate global health burden upon developing countries. An understanding of region specific epidemiological risk factors is imperative in order to plan appropriate prevention and control strategies. The objective of the study was to evaluate epidemiological risk factors of road traffic injury victims in Delhi, India with the help of Haddon injury analysis framework. The current study was conducted among crash victims admitted to the government hospital. Data obtained from the hospital, police records and crash victims was triangulated with geospatial analysis. Haddon matrix was utilized to understand the interplay of human, vehicle and environmental factors in pre-crash, crash and post-crash phases of an accident. A total of 544 victims were included as study participants with mean age of 30.8 years for males and 31.81 years for females and were from lower socio-economic groups. Pedestrians (36.2%) and two-wheeler riders, especially those on pillion vehicles (21.5%), were worst affected victims. The crude odds ratio for motorized road users for experiencing a crash was higher on slippery roads [p

Globally, the leading cause of morbidity and mortality among infants, children, and adolescents is trauma. Although pediatric injury is well studied in the developed world, much is unknown regarding childhood injury in low- and middle-income countries (LMICs). Understanding the epidemiology of injury among children may facilitate the development of prevention initiatives and preparation of the health system to care for these patients. In this chapter, we review the classification systems and common mechanisms and risk factors of injury. To reduce the rates of pediatric injury and improve the outcomes of injured children, systematic data collection and review should be a component of clinics, hospitals, and health systems. Additionally, the surgeon can play a role in injury control through championing local or wider surveillance, counseling children and parents in prevention, organizing trauma care, performing research, and advocating for better resources.

Specialists of different fields (from traffic management and control to logistics) are interested in the market of autonomous cars development. This could give a synergistic effect, because it can improve reliability, safety, efficiency and sustainability of the transport system. However, intellectualization of the transport system requires solving problems that arise (here, under the intellectualization we understand the process of transforming the transport system into the Intelligent Transport System). We propose the classification of risks that will arise while transport system’s intellectualization. Classifier is made in accordance with risk characteristics that will allow directing efforts to prevent the most probable risks, as well as to reduce their severity in case of occurrence. We also suggest software based on a multiple-factor analysis of information that identifies the causes of critical situations. We have modified Haddon matrix, which allows determining factors that affect the number of accidents and the severity of their consequences, as well as the measures most effectively contributing to improving road safety. If recommendations’ implementation caused increase of road safety, the proposed software enters these scripts into the knowledge base. This has allowed us to conclude what actions have helped to increase road safety in the city and what have to be corrected. If recommended decisions haven’t had an expected positive effect, Haddon matrix was revised and adjusted in accordance with the actual results.

Automated driving systems (ADS) have the potential for improving safety but also pose the risk of extending the transportation system beyond its edge conditions, beyond the operating conditions (operational design domain (ODD)) under which a given ADS or feature thereof is specifically designed to function. The ODD itself is a function of the known bounds and the unknown bounds of operation. The known bounds are those defined by vehicle designers; the unknown bounds arise based on a person operating the system outside the assumptions on which the vehicle was built. The process of identifying and mitigating risk of possible failures at the edge conditions is a cornerstone of systems safety engineering (SSE); however, SSE practitioners may not always account for the assumptions on which their risk mitigation resolutions are based. This is a particularly critical issue with the algorithms developed for highly automated vehicles (HAVs). The injury prevention community, engineers and designers must recognise that automation has introduced a fundamental shift in transportation safety and requires a new paradigm for transportation epidemiology and safety science that incorporates what edge conditions exist and how they may incite failure. Towards providing a foundational organising framework for the injury prevention community to engage with HAV development, we propose a blending of two classic safety models: the Swiss Cheese Model, which is focused on safety layers and redundancy, and the Haddon Matrix, which identifies actors and their responsibilities before, during and after an event.

The recruitment and retention of health professionals in rural Australia is well documented. The COVID-19 pandemic has further exposed the precariousness of human healthcare resources within small rural communities. The external disaster of the COVID-19 outbreak described in this case analysis exacerbated the frail balance of sustaining adequate staffing levels and skill mix, which exposed behaviours of presenteeism within rural healthcare teams. An analysis of the complex of factors that led to the first nosocomial outbreak of COVID-19 within a healthcare environment in Australia demonstrates how rural healthcare environments are ill-equipped to meet the demands of unexpected external disasters. Using the Haddon Matrix to examine the factors that led to this outbreak provides us with the opportunity to learn from the case analysis. Health professional presenteeism contributed to the North West Tasmania COVID-19 outbreak and affected the hospital and health service provision within the region. Recommendations to mitigate risk for future disaster planning in rural healthcare environments include improved infection control strategies and a whole-community approach.

ObjectiveTo (i) identify person, vehicle and environmental risk factors for injury among children using motorcycles, and (ii) identify and appraise studies of interventions designed to reduce the occurrence or severity of injury among children using these vehicles.MethodA systematic approach was used to collate data from published and grey literature globally on risk factors for motorcycles injury, and studies reporting evaluation of interventions to counter this injury. Academic data sets and public search engines (including Google and Yahoo!) were used. Websites of major conferences, organisations and networks were also searched. Finally, researchers and units working in this area were also contacted by email or phone seeking relevant research. All study types were eligible, excluding clinical case studies. The Haddon Matrix was used as a framework for synthesising the data.ResultsThe review revealed that robust investigations of risk factors for injury among children using motorcycles are relatively scarce, and there are few interventional studies reporting effectiveness of countermeasures to this problem. Epidemiological literature is generally limited to discussion of human factors, and less attention has been given to vehicle and environmental factors. Furthermore, much of the literature is commentaries and descriptive studies. There has been little rigorous study of risk factors unique to children riding motorcycles.ConclusionsThis first attempt at extensively reviewing literature related to risk factors and interventions for children and motorcycles using the Haddon Matrix as a framework clearly highlights need for more rigorous study as information is lacking in all cells of this matrix.

Few studies exist on wrong-way driving (WWD) on divided highways. Earlier findings on contributing factors and countermeasures mostly have been on freeways. This study filled the gap through the conduct of an in-depth investigation of WWD crashes exclusively on divided highways in Alabama. Extensive efforts were made to analyze WWD crash data through the use of the Haddon Matrix and field observations. General issues, contributing factors, and countermeasures were identified through in-depth analyses of individual crashes and field review of crash locations and WWD entry points. On the basis of study conclusions, recommendations are made to reduce the possibility and severity of WWD on divided highways.

Accident Analysis & Prevention (AA&P) is a leading academic journal established in 1969 that serves as an important scientific communication platform for road safety studies. To celebrate its 50th anniversary of publishing outstanding and insightful studies, a multi-dimensional statistical and visualized analysis of the AA&P publications between 1969 and 2018 was performed using the Web of Science (WoS) Core Collection database, bibliometrics and mapping-knowledge-domain (MKD) analytical methods, and scientometric tools. It was shown that the annual number of AA&P's publications has grown exponentially and that over the course of its development, AA&P has been a leader in the field of road safety, both in terms of innovation and dissemination. By determining its key source countries and organizations, core authors, highly co-cited published documents, and high burst-strength publications, we showed that AA&P's areas of focus include the "effects of hazard and risk perception on driving behavior", "crash frequency modeling analysis", "intentional driving violations and aberrant driving behavior", "epidemiology, assessment and prevention of road traffic injuries", and "crash-injury severity modeling analysis". Furthermore, the key burst papers that have played an important role in advancing research and guiding AA&P in new directions - particularly those in the fields of crash frequency and crash-injury severity modeling analyses were identified. Finally, a modified Haddon matrix in the era of intelligent, connected and autonomous transportation systems is proposed to provide new insights into the emerging generation of road safety studies.

Background: Various models have been used to portray the causal pattern of Road Traffic Injuries (RTIs). Of which one most frequently used is the Haddon’s matrix proposed in 1970. The aim of this study was to improve applicability of this model through extending for road safety promotion. Methods: Required data gathered from 57 articles on influencing factors in RTIs and analyzed using Content- Analysis method by using the Haddon’s matrix. Six national expert’s opinions were applied in extension of model. Results: Initially 467 factors were extracted. After removing the duplicates and merging the similar factors, finally 76 factors remained. The pre-event phase had the most factors (N=41). Of the columns, the Vehicle and equipment had the most factors (N=26). According to extracted factors and experts opinion columns extended to 7 categories (human, environmental, vehicle and equipment, road, socio-economic, structure and organizational, mixed). Rows extended to two categories included: pre-event (long term and short term) and post-event (crash scene, transfer, care delivery). Conclusions: In this study the results of the studies on influencing factors in RTIs and the experts’ opinions were used to develop an expanded model of Haddon’s Matrix which is specific to traffic accidents. Future studies might investigate the effectiveness of this expanded model. Keywords: Prevention, Road Traffic Injuries, Haddon matrix, Causal pattern, applicability

Pediatric emergency centers treat millions of unintentional injuries cases every year, and many of these injuries could have potentially been avoided by proper counseling about trauma safety and prevention. Through such discussions, clinicians have the ability to meaningfully decrease the number of these unintentional injuries. Not enough attention has been placed on critically injured children and adolescents who have a substantial burden on health care resources and morbidity. Emergency medicine providers and pediatricians have the responsibility to educate patients and families about proper child passenger safety and to remain up to date on this information. However, numerous barriers still exist for physicians to fully counsel patients and their families about firearms. Pediatric emergency medicine physicians can play a foundational role in the safety, prevention, and treatment of childhood injuries. Clinicians can become effective instructors for injury prevention by using the Haddon Matrix: host, agent, and environment; and the 3 Es of injury prevention: education, engineering, and enforcement of strategies. Legislative changes, educational approaches, and product modifications must come together to effectively achieve this goal. Although the idea of educating families in the emergency department may seem ideal because the immediacy of the current injury may make the families more receptive to the counseling, the integration of primary care physicians is beneficial for regular follow-ups and maintenance.

Background Curve with hundred bodies is called Thungyai-Phrasaeng Road which is a two-lane road. There is no pavement and no lights at night. Area with sharp turn located on Moo 6, Tambon Thungsung, Amphur Thungyai, Nakornsrithammarat Province had the highest road accidents statistics during 2012–2014 at 32–58 times per year and 90% of death were local people. Objective Communities participate in accident prevention resulting in reduction in the number of injuries/deaths from road accidents in risk areas. Methods: Investigate accidents through community participation Tools Haddon matrix/PAR Results: Village Health Volunteers, local people, are part of road safety working group. As a result, every road accident was investigated. The result of analysis of the causes of injuries led to solutions that can be managed by the community. In the wilderness area by sharp-turn curve, Village Health Volunteer organized the team to forest the pavement every month and provide long-term monitoring. Then bring the analysis results to the responsible agents which leads to pavement adjustment and pavement mount-lighting for night time. Therefore, the number of collisions reduced and there was no death. Name: Village Health Volunteer (VHV). Results of correction at risk area by interdisciplinary team at Tha Sala Miss Sabay Yeesa, Registered Nurse (Professional Level), Tha Sala Hospital S_yeesa@yahoo.com Introduction Thungnai T-junction is one of risk areas in Tambon Tha Khuen, Amphur Tha Sala, Nakornsrithammarat Province. In 2016, there were 12–15 accidents or average of 1–2 times per month. There was 1 death from people in the village. From this incident, it is the starting point for analyzing the cause of accidents by interdisciplinary team, together with local Sub District Administrative Organization Tha Khuen, Amphur Tha Sala and Sub District Administrative Organization Kra Rho, Amphur Noppitum with the host team, highway, Nakornsrithammart Amphur Noppitum. Methods Collected information of injuries, deaths and collisions; Conducted road survey to check road conditions; and brought information and presented at the meeting of village headman, headman, 2 Sub District Administrative Organizations and highway Nakornsrithammarat the cause resulted from unclear lines and it is curved shape. There were 3 suggestions to solve the problems: clear markings on the road, make a hazard bar at the junction of the reflector or the barrage, and set the community checkpoint during festive seasons. Results: Since an improvement of the operation of risk area in late October 2016, there were no collisions.

This Participation action research aims to: 1. Analysis of traffic accidents 2. Develop a model to reduce traffic accidents with 5S strategies. Community participation and evaluation of the use of accident reduction. Research tools include: Method of operation 1) Study the context of traffic accident by using information (S1) from report (traffic, company And the Haddon Matrix. (s. 2).59 villages surveyed. Risk and planning. 2) Risk prevention plan with multidisciplinary team. ) Invited participants 5 pillars. Traffic, Local, Hospital, Transportation, Transportation Best Value (4). 3) Implement the Participation Plan 5). There were 59 accident prevention partners, president by the sheriff. Follow the agenda. 4) Reflect the information back in the meeting. Each project a quality wheel (Plan, Do, Check, Act) under the concept of clear goals. Performance: Traffic accidents occurred in working men between 17.00–22.00 pm, alcoholic drinks (80.66%), motorcycles (81.22%), and roadside villages (55.08%). The death rate from traffic accidents decreased from 11.75 to 4 per 1 00 000 population. The number of accidents decreased from 936 to 602, the lowest in the province for 3 years. Both 59 villages and 5 pillars of the district. Continuous operation Criticism and summary/Suggestions The results of this project can create individuals and prototype families. There were innovations as follows: 1 Tambon 10 Kms Reduced Duration 2) EMS Member Club 1,Just One Click 3) White trees Suggestions should be constantly monitored because traffic accidents can occur at any time. They should be adapted to the context and adapted to the activity Plans to continue 1. Connect to Service Plan 2. Develop Fast Tract 3. Link with DHS-RTI and cultivate in youth and prototype groups to create a culture of safety. To build sustainability

Background Each year, over 15,000 preschoolers die from unintentional injuries in China. Many interventions proven to work in other nations have not been implemented nationwide in China. The rapid popularity of smartphones offers an opportunity to overcome this limitation and disseminate evidence-based interventions to the large population of China. This study aims to assess the effectiveness of an app-based intervention for caregivers of preschoolers to prevent unintentional injury among young Chinese children. Method A single-blinded, 6-month, parallel-group cluster randomized controlled trial with 1:1 allocation ratio will be conducted in Changsha, China. In total, 2626 caregivers of preschoolers ages 3–6 years old who own a smartphone will be recruited from 20 preschools. Clusters will be randomized at the preschool level and allocated to either the control group (routine education plus app-based parenting education excluding unintentional injury prevention) or the intervention group (routine education plus app-based parenting education including unintentional injury prevention). The app-based injury prevention program was developed based on the Theory of Planned Behavior, the Haddon Matrix, the Mobile Learning framework, and a needs assessment. Data collection will be conducted at baseline, 3-month, and 6-month follow-up via app-based survey plus printed questionnaire survey. The primary outcome measure is unintentional injury incidence among preschoolers in the past 3 months. Secondary outcome measures include economic losses due to unintentional injury in the past 3 months, the Incremental Cost-Effectiveness Ratios (ICERs), and parent’s attitudes and behaviors concerning supervision to prevent preschooler unintentional injury in the past week. An intention-to-treat approach will be used to evaluate outcome measures. Chi-square tests will examine differences for outcome measures between groups at each time point and generalized estimation equations (GEE) will test the overall effectiveness of the app-based intervention. Missing outcome data will be imputed using the Expectation Maximization algorithm (EM). Discussion This trial will examine evidence concerning the effectiveness of an innovative app-based intervention for caregivers of Chinese preschoolers. If effective, the app-based intervention could offer an effective population-based intervention option to cost-effectively promote unintentional injury prevention in countries and regions where injury control is under-supported. Trial registration ChiCTR-IOR-17010438. Registered 15 January 2017. Electronic supplementary material The online version of this article (10.1186/s12889-018-5790-1) contains supplementary material, which is available to authorized users.

Background The aim of this study was to analyze the epidemiology of patients admitted with finger amputations in the U.S., as well as to evaluate and propose prevention strategies. Methods The National Electronic Injury Surveillance System was queried to obtain data on patients that presented to, and were admitted from US emergency departments for treatment of traumatic finger amputations during the period of 2002–2016. The Haddon Matrix, a framework that can be used to analyze the host, agent, and environmental factors of an injury relative to its timing, was then used to evaluate possible contributing factors of amputation events, and thereby explore plausible prevention interventions. Results From 2002 to 2016, approximately 348,719 people were admitted from the ED for traumatic amputations. The majority were Caucasian and were male. The mean age was 42.3 years old. This was significantly older than those who were not admitted. The top five products responsible for amputations in admitted patients were power saws (40.9% of cases), doors (10.3%), lawn mowers (7.4%), snow blowers (4.3%), and bicycles (2.4%). This list included a higher proportion of powered tools than those with finger amputations who were discharged from the ED with a finger amputation. Conclusion Patients admitted with finger amputations from the ED were older, more likely to be male, and more likely to be victims of powered tools than those that were discharged. Table saws are responsible for a high proportion of the finger amputations that result in hospital admissions. The Haddon Matrix helps us identify factors (host, agent, physical environment, and social environment) to be addressed in prevention strategies. Such approaches might include championing education campaigns, policy measures, and equipment safety features. The effectiveness of such strategies warrants further investigation.

Practical Implications – Medical definitions of injury severity require observation by trained medical professionals and access to private medical records, limiting their use in routine crash data collection. Crash severity is more sensitive to human and vehicle factors than environmental or road factors. Unfortunately, human and vehicle factor data are generally not available for aggregate forecasting.

The article provides an analysis of the global trends in the field of city transport systems' safety. It is shown that the decrease in the safety of traffic is one of the consequences of the growth of motorization. The efficiency of measures to prevent traffic accidents is analyzed from the viewpoint of their role in the process to ensure safety and sustainability of the urban transportation system. Currently, the efforts to increase the proportion of trips made by foot or by non-motorized transport are made. That is why the problem of ensuring safety of the most vulnerable road users is relevant. One of methods to prevent traffic accidents is to identify potentially dangerous road users, whose behavior may lead to serious consequences. Technical equipment, as well as active control from the side of the services, that ensure road safety, are used to identify violators. Official statistics of the State Inspectorate for Traffic Security is used as initial information. According to the Haddon matrix, there should be 3 stages to decrease the number, as well as the severity of traffic accidents. From our point of view, the most important stage is the phase “before the traffic accident”. The statistics of traffic accidents with victims, as well as the factors that cause such accidents, are analyzed. Simulation has shown, that rational management can reduce the likelihood and the severity of road traffic accidents. Ways to improve efficiency of the above mentioned traffic accidents' prevention measures are proposed.

To investigate the contributing factors for wrong-way crashes on freeways based on information available from crash databases and crash reports, causal tables and a Haddon matrix are used to analyze fatal and injury-related crashes caused by wrong-way driving from 2004 to 2009 in Illinois. For the first step, causal tables are generated based on the police crash reports, in which the percentage of crashes caused by each factor is calculated. Based on these percentages, the contributing factors are ranked. Next, a Haddon matrix is developed for each wrong-way crash in which different factors are identified separately for periods before, during, and after the crash. These factors include drivers' age, drivers' condition, crash causes, vehicle types, vehicle maneuvers, roadway conditions, weather, and wrong-way entry points. For a crash with multiple contributing factors, a weighted point is calculated and assigned to each factor. The total points for each factor are used to rank the order of all contributing factors. Furthermore, a significance test is used to analyze the statistical significance of each of those factors. The analysis results indicate that alcohol impairment, darkness, and driver's age and skill are among the top contributing factors for wrong-way crashes. Language: en

The definitive version of record of this article is available at https://doi.org/10.1016/j.avb.2015.09.004., Recognizing the need for a more comprehensive approach to preventing child homicides that result from family violence, the authors applied Haddon’s three methods of injury prevention to the context of family violence: modification of the agent of injury; identification of control strategies to intervene in the process of injury; and application of the comprehensive Haddon Matrix to explore pre-event, event, and post-event strategies addressing the child, parent, and the environment. Examples of evidence-based strategies were identified to support this approach, and innovative strategies were suggested which build on existing approaches applied to other contexts. Recommendations and implications for research and practice are discussed.

Snow sports (alpine skiing/snowboarding) would benefit from easily implemented and cost-effective injury prevention countermeasures that are effective in reducing injury rate and severity. For snow sports, to identify risk factors and to quantify evidence for effectiveness of injury prevention countermeasures. Searches of electronic literature databases to February 2014 identified 98 articles focused on snow sports that met the inclusion criteria and were subsequently reviewed. Pooled odds ratios (ORs) with 90 % confidence intervals (CIs) and inferences (percentage likelihood of benefit/harm) were calculated using data from 55 studies using a spreadsheet for combining independent groups with a weighting factor based on quality rating scores for effects. More experienced skiers and snowboarders are more likely to sustain an injury as a result of jumps, while beginners sustain injuries primarily as a result of falls. Key risk factors that countermeasure interventions should focus on include, beginner skiers (OR 2.72; 90 % CI 2.15–3.44, 99 % most likely harmful), beginner snowboarders (OR 2.66; 90 % CI 2.08–3.40, 99 % harmful), skiers/snowboarders who rent snow equipment (OR 2.58; 90 % CI 1.98–3.37, 99 % harmful) and poor visibility due to inclement weather (OR 2.69; 90 % CI 1.43–5.07, 97 % harmful). Effective countermeasures include helmets for skiers/snowboarders to prevent head injuries (OR 0.58; 90 % CI 0.51–0.66, 99 % most likely beneficial), and wrist guards for snowboarders to prevent wrist injuries (OR 0.33; 90 % CI 0.23–0.47, 99 % beneficial). The review identified key risk factors for snow-sport injuries and evaluated the evidence for the effectiveness of existing injury prevention countermeasures in recreational (general public use of slopes, not racing) snow sports using a Haddon’s matrix conceptual framework for injury causation (host/snow-sport participant, agent/mechanism and environment/community). Best evidence for the effectiveness of injury prevention countermeasures in recreational snow sports was for the use of helmets and wrist guards and to address low visibility issues via weather reports and signage.

The present paper provides a comprehensive review of past research that examined accident factor on the road accident. Articles and publications were selected for relevance and research strength through a comprehensive search of major databases such as Science Direct, UiTM EZAccess, and Transportation Research Information Services (TRIS). A total of 40 articles were analyzed on the accident factors and categorized using Haddon matrix method. There are three major factors that contribute to the road accident which are human behavior, road environment, and vehicle condition. The result of findings shows that human behavior contributes the highest factor on road accident by accounting for 41% and then followed by environment factor contributed 26% and vehicle factor contributed 33%.

One in five undergraduate women have reported experiencing sexual assault since entering college. This study aimed to: 1) review the literature on evaluated interventions addressing sexual assault on college campuses, 2) provide an analysis of this literature using the Haddon Matrix as an organising framework, and 3) identify gaps in the evidence and opportunities for research and practice. A systematic literature review was conducted in October 2016 using Pubmed, PsycINFO, and SCOPUS. Included studies were published in a peer-reviewed journal between January 2001 and September 2016, used an experimental or quasi-experimental design, were conducted with English speaking college undergraduate students in the US and reported on sexual assault, sexual violence, and/or rape experiences, knowledge, beliefs, and behaviours. Full text articles were reviewed, coded and categorised in the Haddon Phase-Factor Matrix. 194 abstracts were initially identified. After removing duplicates, 170 were reviewed for potential inclusion, and 29 articles were included. 21 studies were RCTs, 8 were quasi-experimental designs. Interventions varied across the studies, although many (n=14) involved bystander interventions. Most interventions were categorised as addressing the host (victim/potential victim) and the social environment (bystanders), and across all phases (pre-event, event, and post-event) of an assault. Impacts were typically assessed by self-report measures administered before the program and at least at one follow up point. Most studies reported a statistically significant change in at least one outcome measure, such as decreased rape myth acceptance and increased bystander efficacy and intentions. Few evaluated interventions were identified in the peer-reviewed literature. Few focused on the agent (perpetrator), and none addressed the physical environment (e.g., presence of security). These results can be used by professionals working to reduce sexual assault on college campuses to draw from the evidence about what works. A number of conceptual and practical gaps for future research are identified.

BackgroundIn the decades since the landmark report-America Burning-was published in 1973, the number of home fire deaths has shrunk from >5500 per year to 2650 in 2015. This paper: (1) describes how science and practice in injury prevention and fire and life safety contributed to successful interventions, and (2) identifies emerging strategies and future opportunities to prevent home fire-related deaths.MethodsThe aims are addressed through the lens of population health research, with a focus on the work of selected Centers for Disease Control and Prevention-funded Injury Control Research Centers. Results are organised using the Haddon Matrix and an ecological model.ResultsWe found evidence to support interventions that address all components of both the matrix and the model, including: reduced ignition propensity cigarettes, stop smoking campaigns, housing codes, residential sprinkler systems, smoke alarms, community risk reduction, school-based educational programmes, and fire and burn response systems. Future reductions are likely to come from enhancing residential sprinkler and smoke alarm technology, and increasing their utilisation; expanding the use of community risk reduction methods; and implementing new technological solutions. Despite the successes, substantial disparities in home fire death rates remain, reflecting underlying social determinants of health.ConclusionMost of the evidence-supported interventions were focused on changing the policy and community environments to prevent home fires and reduce injury when a fire occurs. Future prevention efforts should give high priority to addressing the continued disparities in home fire deaths.

ObjectiveUnderground mining is associated with obvious risks that can lead to mass casualty incidents. Information about such incidents was analyzed in an integrated literature review.MethodsA literature search (1980-2015) identified 564 modern-era underground mining reports from countries sharing similar occupational health legislation. These reports were condensed to 31 reports after consideration of quality grading and appropriateness to the aim. The Haddon matrix was used for structure, separating human factors from technical and environmental details, and timing.ResultsMost of the reports were descriptive regarding injury-creating technical and environmental factors. The influence of rock characteristics was an important pre-event environmental factor. The organic nature of coal adds risks not shared in hard-rock mines. A sequence of mechanisms is commonly described, often initiated by a human factor in interaction with technology and step-wise escalation to involve environmental circumstances. Socioeconomic factors introduce heterogeneity. In the Haddon matrix, emergency medical services are mainly a post-event environmental issue, which were not well described in the available literature. The US Quecreek Coal Mine incident of 2002 stands out as a well-planned rescue mission.ConclusionEvaluation of the preparedness to handle underground mining incidents deserves further scientific attention. Preparedness must include the medical aspects of rescue operations. (Disaster Med Public Health Preparedness. 2018;12:138–146)

Sudden cardiac arrest remains an important health care problem. If survival rates of all regions would equal those of the best performers, literally thousands of lives would be saved. Similar to injury, there is a need for an epidemiology-based approach for planning and execution of countermeasures. In this policy paper, we present the Haddon Matrix as an all-inclusive conceptual framework to assist in this. We advocate for a more community-centred 'public health' approach, with a crucial role for policy-level executives. There is a large potential gain in outcome by implementing 'passive' - not requiring individual action - measures. As happened for injury, 'Cardiac Arrest Academies' should be created to facilitate and coordinate this process. (C) 2014 Elsevier Ireland Ltd. All rights reserved.

Safety is a key issue for transport policy globally. Work-related travel has a significant impact on both road and occupational safety. Implementing a long term, sustainable work-related road safety program is a complex process requiring careful management decision making. Despite an increasing interest in research, policy and practice, there remain few published studies of organisations that have effectively managed their travel risks. The aim of this paper is to review and evaluate the outcomes of a driver risk assessment, monitoring and improvement program undertaken by British Telecommunications throughout its UK operations. The material presented is based on a detailed case study of the policies, procedures and performance monitoring implemented to manage the road safety risks of approximately 95,000 workers over more than 10 years. From a review of processes and outcomes, a good practice data-led systems-based approach is identified, focusing on occupational health and safety principles, the Haddon Matrix, risk assessment and evaluation. The case, which has seen a halving of the company׳s collision rate and costs, provides access to large insurance claims and other data sets over a long term period. A number of potential lessons for researchers, policy makers and practitioners are identified relating to issues such as data, management, tools, frameworks and further opportunities to focus on improving both road and worker safety.

In recent years, disaster management has been the focus of attention since disasters have been associated with huge destructions and consequences. Basically, disaster management techniques aim at the prevention and mitigation works as well as promotion of resilience. Haddon matrix was proposed as a conceptual model to understand the event and provide preventive measures in the field of injury prevention. This matrix is a combination of epidemiological triangle, including host, agent, and environmental factors at three levels of prevention, including pre-event, event, and post-event. In spite of frequent application of Haddon strategies in prevention of various injuries; hitherto, application of Haddon matrix in disaster management has been rarely investigated. However, its potential capability for managing disasters calls for its further introduction which is the main focus of our study.

Self-poisoning with pesticides or plants is a major clinical problem in rural Asia, killing several hundred thousand people every year. Over the last 17 years, our clinical toxicology and pharmacology group has carried out clinical studies in the North Central Province of Sri Lanka to improve treatment and reduce deaths. Studies have looked at the effectiveness of anti-digoxin Fab in cardiac glycoside plant poisoning, multiple dose activated charcoal in all poisoning, and pralidoxime in moderate toxicity organophosphorus insecticide poisoning. More recently, using a Haddon matrix as a guide, we have started conducting public health and animal studies to find strategies that may work outside of the hospital. Based on the 2009 GSK Research in Clinical Pharmacology prize lecture, this review shows the evolution of the group's research from a clinical pharmacology approach to one that studies possible interventions at multiple levels, including the patient, the community and government legislation.

Occupational injuries and workplace violence are defined and discussed in terms of their nature, scope, and importance as public health problems. The public health approach to injury prevention is described and distinctions and commonalities between occupational and nonoccupational injuries presented. Also described are sources of occupational injury data; causal and risk factors; prevention strategies, including the Haddon Matrix and hierarchy of controls; and strategies for transferring injury prevention research results to workplace practice. Workplace violence discussions include the role of surveillance; risk factors; and prevention approaches, including legislative, administrative and behavioral, and environmental design approaches.