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The Effects of Bicycle Helmets and Helmet Legislation on the Severity of Children’s Head Injuries
Karlstad University, Faculty of Health, Science and Technology (starting 2013), Centre for Public Safety. Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Environmental and Life Sciences. (Centre for Public Safety)ORCID iD: 0000-0002-1189-9950
Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Karlstad Business School.ORCID iD: 0000-0002-7143-8793
(English)Manuscript (preprint) (Other academic)
National Category
Economics Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public Health Science
Identifiers
URN: urn:nbn:se:kau:diva-41153OAI: oai:DiVA.org:kau-41153DiVA, id: diva2:915197
Available from: 2016-03-29 Created: 2016-03-29 Last updated: 2018-06-04Bibliographically approved
In thesis
1. Assessing the effects of societal injury control interventions
Open this publication in new window or tab >>Assessing the effects of societal injury control interventions
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Injuries have emerged as one of the biggest public health issues of the 21th century. Yet, the causal effects of injury control strategies are often questioned due to a lack of randomized experiments. In this thesis, a set of quasi-experimental methods are applied and discussed in the light of causal inference theory and the type of data commonly available in injury surveillance systems. I begin by defining the interrupted time series design as a special case of the regression-discontinuity design, and the method is applied to two empirical cases. The first is a ban on the sale and production of non-reduced ignition propensity (RIP) cigarettes, and the second is a tightening of the licensing rules for mopeds. A two-way fixed effects model is then applied to a case with time-varying starting dates, attempting to identify the causal effects of municipality-provided home help services for the elderly. Lastly, the effect of the Swedish bicycle helmet law is evaluated using the comparative interrupted time series and synthetic control methods. The results from the empirical studies suggest that the stricter licensing rules and the bicycle helmet law were effective in reducing injury rates, while the home help services and RIP cigarette interventions have had limited or no impact on safety as measured by fatalities and hospital admissions. I conclude that identification of the impact of injury control interventions is possible using low cost means. However, the ability to infer causality varies greatly by empirical case and method, which highlights the important role of causal inference theory in applied intervention research. While existing methods can be used with data from injury surveillance systems, additional improvements and development of new estimators specifically tailored for injury data will likely further enhance the ability to draw causal conclusions in natural settings. Implications for future research and recommendations for practice are also discussed.

Abstract [en]

Injuries have emerged as one of the biggest public health issues of the 21th century. Yet, the causal effects of injury control strategies are rarely known due to a lack of randomized experiments. In this thesis, a set of quasi-experimental methods are discussed in the light of causal inference theory and the type of data commonly available in injury surveillance systems. I begin by defining the identifying assumptions of the interrupted time series design as a special case of the regression-discontinuity design, and the method is applied to two empirical cases. The first is a ban on the sale and production of non-fire safe cigarettes and the second is a tightening of the licensing rules for mopeds. A fixed effects panel regression analysis is then applied to a case with time-varying starting dates, attempting to identify the causal effects of municipality-provided home help services for the elderly. Lastly, the causal effect of the Swedish bicycle helmet law is evaluated using a comparative interrupted time series design and a synthetic control design. I conclude that credible identification of the impact of injury control interventions is possible using simple and cost-effective means. Implications for future research and recommendations for practice are discussed.

Place, publisher, year, edition, pages
Karlstad: Karlstads universitet, 2016. p. 59
Series
Karlstad University Studies, ISSN 1403-8099 ; 2016:23
Keywords
causal inference, epidemiology, injury, time series analysis, impact evaluation
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Risk and Environmental Studies
Identifiers
urn:nbn:se:kau:diva-41204 (URN)978-91-7063-701-8 (ISBN)
External cooperation:
Public defence
2016-05-19, Eva Erikssonsalen, 21A342, Karlstad, 13:00 (Swedish)
Opponent
Supervisors
Funder
Swedish Civil Contingencies Agency
Available from: 2016-04-29 Created: 2016-04-01 Last updated: 2016-08-25Bibliographically approved

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Bonander, CarlJakobsson, Niklas

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