Effectiveness of two interventions in preventing traffic accidents: a systematic review.
BACKGROUND
The prevention of road traffic accidents should be considered a serious public health concern, since they are the eighth leading cause of death globally and the main cause of death for young people aged 15-29. Evidences from many countries show that successes in preventing road traffic injuries can be achieved through concerted efforts at national level. The aim of our study was to assess the effectiveness of two interventions to prevent road traffic accidents: the introduction of graduated driver licensing (GDL) and the interventions to improve pedestrian and cyclist visibility.


METHODS
Our search started with a scoping review on the interventions to prevent road traffic accidents to allow the development of a logical framework of traffic accidents. Specific and answerable questions formulated according to PICO scheme and combinations of keywords were used to perform a systematic search in the following databases: Pubmed, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (DARE), Health Evidence, Transport Research International Documentation (TRID) and Google. References of selected papers were searched. Only systematic reviews and meta-analyses were eligible. No temporal limits or linguistic filters were applied.


RESULTS
160 systematic reviews and meta-analyses were found for the question of the introduction of GDL program and 188 on the improvement of visibility in cyclists and pedestrians. After selection, four papers were included in qualitative synthesis for each question. All included studies underwent quality evaluation. GDL programs seem to be effective in reducing crash rates among young drivers, in particular in 16 year-old. Programs with more restrictions seem also to reduce fatal events. To improve visibility of pedestrians and cyclists, street lighting has been suggested as an intervention able to improve driver's visual capabilities and ability to detect roadway hazards and to prevent car crashes. Visibility aids (fluorescent materials, lamps, flashing lights and retroreflective materials) have the potential to increase visibility and enable drivers to detect pedestrians and cyclists earlier.


CONCLUSIONS
The two interventions seem to be effective, but further examinations are needed to measure long-term effects. It is necessary to provide feasible studies in local context to estimate the impact of introduction of GDL programs or of some of their components and to improve interventions to increase visibility of pedestrians and cyclists.
School of Specialization in Hygiene and Preventive Medicine, University of Florence, Italy.
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Porchia
Tuscany Regional Centre for Occupational Injuries and Diseases (CeRIMP), Florence, Italy.
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Baldasseroni
Regional Health Agency of Tuscany, Italy.
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Dellisanti
Department of Health Science, University of Florence, Italy.
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Lorini
Department of Experimental and Clinical Medicine, University of Florence, Italy.
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Bonaccorsi
D000063:Accidents, Traffic / Q000517:prevention & control*; D001334:Automobile Driving / Q000193:education / Q000592:standards; D001642:Bicycling; D006801:Humans; D016138:Walking