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By Andrea C.Gielen, David A.Sleet and Ralph J.DiClemente . Published by Jossey-Bass , San Francisco , California , 2006 . 534 pages . ISBN 978 0 7879 7764 1 .

Reviewed by Pam Albany, Injury Prevention Policy Branch, New South Wales Health Department

There has long been an ideological disagreement among researchers and practitioners of injury prevention concerning the most effective investment to use for real-time results. In the vernacular, “What is the best bang for the buck?” Most have said that regulatory imperatives deliver the best results, more quickly. In one sense they are correct. Regulation can deliver protective behaviour change more quickly than appealing to the individual's acceptance of the notion of risk and then waiting for them to take action on it.

What is not appreciated in this statement is that, in order to deliver on this regulatory program (e.g. all cyclists wearing helmets, all children being appropriately restrained in motor vehicles, all at-risk medications being dispensed in protective packaging), a great number of people need to be persuaded about the risks associated and the protective behaviour required to maximise compliance. It is this understanding that drives appropriate enforcement, obligatory behaviour and community acceptance.

Injury and Violence Prevention by Gielen, Sleet and DiClemente successfully teases out the finer points of the behaviour change discussion and brings to the debate a science of behaviour change, which, if they are honest, will cause the ideologues to reconsider their attitudes. The authors/editors are themselves well known in behavioural science, injury prevention, and public health – a rare combination to find. The book conveys prominent behavioural/science models and applies them to a range of risk environments and behaviours.

In part one, the authors present a clear and distinct map of the range of change behaviour and planning theories and models – such as social cognitive theory, PRECEDE-PROCEED, the health belief model and others – and apply them to the various aspects of preventing injury. This is likely to be the most valuable and unique feature of the book, as all three editors have wide experience in theory-driven interventions.

Part two provides a useful summary of the range of behavioural research and assessment methods to be applied. This is also the first time we have seen an explication of behavioural research methodology applied to injury prevention.

Part three provides a summary of the applications of theory to a range of risk environments and behaviours; road safety, alcohol consumption in relation to road trauma, sport and recreational injury in children and young people, house fires, intimate partner violence, youth and self-directed violence and occupational injury. This is helpful because it demonstrates how behavioural theory can be (and has been) used, with examples and numerous citations from the literature.

Part four discusses a range of cross-cutting issues such as the role of law in affecting behaviour and of human factors in product design and an intriguing look at some future directions. A focus of this section is a discussion about the power of law because of its affect on behaviour. That interplay is often overlooked when practitioners advocate for changes in law as a way to bypass behavioural approaches.

Since I have long held the belief that there is a glaring lack of understanding in the community about risk behaviours and environments, I was particularly attracted to chapter 18, ‘Supervision as a behavioral approach to reducing child injury risk’ (pages 395–418), written by Barbara Morrongiello (from Canada). She is clearly one of the world's experts in this arena.

The community in general instantly espouses supervision as the only viable answer to the increasing risk of trauma to children. This is countered by the fact that many care-givers clearly do not differentiate levels of risk environments and behaviours with life-threatening possibility. For instance, most care-givers are understandably conscious of the level of threat posed by unsupervised use of a firearm by children, but most do not realise that unsupervised use of water can provide the same level of life-threatening risk. I was intrigued to discover that there is little empirical research around this area (other than the use of home safety devices by parents). I found the final section suggesting a range of directions for future research most useful.

Injury and Violence Prevention is a valuable text for new students and for older practitioners alike, and one I wish had been available when I started a career in this difficult arena. Gielen, Sleet and DiClemente have put together a talented and experienced panel of writers to present an integrated and useful approach to the science underpinning an area of endeavour that, at times, struggles to find a place in the political sun. This text presents an opportunity for a clever reappraisal of the imperative to improve the health outcomes of the next generations – if the injury prevention academics and practitioners can take advantage of its insights.