Prevention of childhood injury: clinical and public policy challenges

Injuries are the leading killer of children in the United States, at a rate significantly higher than in other industrialized countries. In this article, we outline how a behaviorally and developmentally based model of prevention may assist in determining effective interventions for various injury risks. Two conclusions emerge: (a) the strength of perceived costs and consequences for taking effective safety actions greatly influences the probability that they will be implemented; and (b) intervening at the most developmentally appropriate time is likely to result in more effective outcomes. Further, clinical psychologists are uniquely suited to assess contingencies that maintain unsafe practices, but we need to enlist the participation of citizens and other professionals to mount persuasive intervention campaigns. Despite strong demonstration projects, childhood injury reduction has lagged behind other public health endeavors. Obstacles to injury prevention include (a) the diffusion of injury threats, complicating the identification of effective targets for intervention; (b) the tendency of parents and even some health professionals to regard injuries as products of fate, which fosters complacency; (c) the failure of U.S. social service policy to support preventive strategies; and (d) an American cultural tradition of opposing regulation. Suggestions for improved public policy and intervention procedures are advanced.