[Evidence-based effectiveness of road safety interventions: a literature review]

Effectiveness of road safety interventions: An evidence and gap map

Background

Road Traffic injuries (RTI) are among the top ten leading causes of death in the world resulting in 1.35 million deaths every year, about 93% of which occur in low- and middle-income countries (LMICs). Despite several global resolutions to reduce traffic injuries, they have continued to grow in many countries. Many high-income countries have successfully reduced RTI by using a public health approach and implementing evidence-based interventions. As many LMICs develop their highway infrastructure, adopting a similar scientific approach towards road safety is crucial. The evidence also needs to be evaluated to assess external validity because measures that have worked in high-income countries may not translate equally well to other contexts. An evidence gap map for RTI is the first step towards understanding what evidence is available, from where, and the key gaps in knowledge.

Objectives

The objective of this evidence gap map (EGM) is to identify existing evidence from all effectiveness studies and systematic reviews related to road safety interventions. In addition, the EGM identifies gaps in evidence where new primary studies and systematic reviews could add value. This will help direct future research and discussions based on systematic evidence towards the approaches and interventions which are most effective in the road safety sector. This could enable the generation of evidence for informing policy at global, regional or national levels.

Search Methods

The EGM includes systematic reviews and impact evaluations assessing the effect of interventions for RTI reported in academic databases, organization websites, and grey literature sources. The studies were searched up to December 2019.

Selection Criteria

The interventions were divided into five broad categories: (a) human factors (e.g., enforcement or road user education), (b) road design, infrastructure and traffic control, (c) legal and institutional framework, (d) post-crash pre-hospital care, and (e) vehicle factors (except car design for occupant protection) and protective devices. Included studies reported two primary outcomes: fatal crashes and non-fatal injury crashes; and four intermediate outcomes: change in use of seat belts, change in use of helmets, change in speed, and change in alcohol/drug use. Studies were excluded if they did not report injury or fatality as one of the outcomes.

Data Collection and Analysis

The EGM is presented in the form of a matrix with two primary dimensions: interventions (rows) and outcomes (columns). Additional dimensions are country income groups, region, quality level for systematic reviews, type of study design used (e.g., case-control), type of road user studied (e.g., pedestrian, cyclists), age groups, and road type. The EGM is available online where the matrix of interventions and outcomes can be filtered by one or more dimensions. The webpage includes a bibliography of the selected studies and titles and abstracts available for preview. Quality appraisal for systematic reviews was conducted using a critical appraisal tool for systematic reviews, AMSTAR 2.

Main Results

The EGM identified 1859 studies of which 322 were systematic reviews, 7 were protocol studies and 1530 were impact evaluations. Some studies included more than one intervention, outcome, study method, or study region. The studies were distributed among intervention categories as: human factors (n = 771), road design, infrastructure and traffic control (n = 661), legal and institutional framework (n = 424), post-crash pre-hospital care (n = 118) and vehicle factors and protective devices (n = 111). Fatal crashes as outcomes were reported in 1414 records and non-fatal injury crashes in 1252 records. Among the four intermediate outcomes, speed was most commonly reported (n = 298) followed by alcohol (n = 206), use of seatbelts (n = 167), and use of helmets (n = 66). Ninety-six percent of the studies were reported from high-income countries (HIC), 4.5% from upper-middle-income countries, and only 1.4% from lower-middle and low-income countries. There were 25 systematic reviews of high quality, 4 of moderate quality, and 293 of low quality.

Authors' Conclusions

The EGM shows that the distribution of available road safety evidence is skewed across the world. A vast majority of the literature is from HICs. In contrast, only a small fraction of the literature reports on the many LMICs that are fast expanding their road infrastructure, experiencing rapid changes in traffic patterns, and witnessing growth in road injuries. This bias in literature explains why many interventions that are of high importance in the context of LMICs remain poorly studied. Besides, many interventions that have been tested only in HICs may not work equally effectively in LMICs. Another important finding was that a large majority of systematic reviews are of low quality. The scarcity of evidence on many important interventions and lack of good quality evidence-synthesis have significant implications for future road safety research and practice in LMICs. The EGM presented here will help identify priority areas for researchers, while directing practitioners and policy makers towards proven interventions.

Use of seat belts among public transport drivers in Tacna, Peru: Prevalence and risk factors

INTRODUCTION

There are individuals who still refuse to wear seat belts, despite its effectiveness in reducing morbidity and mortality in road traffic accidents. We aimed to determine the prevalence and risk factors according to the use of seat belts among public transport drivers in Tacna, Peru.

METHODOLOGY

This analytical transversal study was carried out among public transport drivers (buses and taxis) in a Peruvian city. Questionnaires were used to evaluate the general and occupational characteristics and the use of seat belts (observed). Descriptive statistics and risk factors were obtained, these latter through generalized linear models.

RESULTS

Of the 460 drivers, 77% used their seat belts, with a difference in use depending on the type of public transport (p<0.001). In the multivariate model, the risk of not using the belt was associated with the following: older age (p<0.001), having complete studies (p<0.001), a higher level/category of driving license (3 categories had p<0.001), having a higher number of previous road traffic accidents (p = 0.011), and received medical attention in that accident (p<0.001), those who reported using a cell phone while driving (p = 0.005), if the co-driver's belt had 3 anchorage points (p<0.001), and working for > 5 hours that day (p = 0.002). However, male drivers and those who had their belt with 3 anchorage points had greater use (both p<0.001).

CONCLUSIONS

One in five drivers did not use a seat belt, and important characteristics of those who did not comply with this traffic law were evaluated to generate control and intervention measures.

[Provincial savings of costs in road accidents in Spain (2000-2014)]

OBJECTIVE

To quantify cost savings obtained before and after the implementation of the penalty-points driving licence on the interurban roads in Spain.

METHOD

Descriptive study through the construction of three indicators that expressed the cost savings by the number of victims avoided. We defined two periods according to the objective and collected data on fatalities, serious injuries and slight injuries on interurban roads in 1999-2014 for each Spanish province. Thus, data for its population, GDP or number of vehicles-kilometres travelled on its roads (MVKT) were used for each province. The quantification of savings was obtained using official figures of costs for each type of victim in 2014 prices.

RESULTS

The cost savings per inhabitant on fatalities in the period of validity of the penalty-points driving licence was between ⿬ 3.89 and ⿬ 19.65 per year. Savings on serious injuries by MVKT were reduced by 15%-66% between 2006 and 2014, being from ⿬ 449.15 to 1707.88 ⿬ annually.

CONCLUSIONS

During the period of validity of the penalty-points driving licence, the Spanish provinces have achieved significant cost savings.

Road risk behaviors: Pedestrian experiences

Objective: The objective of this study was to identify pedestrian risk behaviors that result in traffic accidents and characterization of the accidents experienced by participants in this study to provide information for the generation of integral preventive strategies. Methods: The study was correlational, descriptive, and transversal and followed a quantitative approach divided into 2 stages. In the first stage, an observational study was performed to identify the manifested risk behaviors of pedestrians, which served as a basis for the construction and design of a questionnaire. In the second stage, the questionnaire was applied to a group of 1,536 participants. Pearson's correlation coefficient was applied to establish associations between gender and age with respect to risk behaviors. Results: The 3 behaviors that participants reported performing always or very often include using electronic gadgets (except mobile phones), not using a pedestrian crosswalk, and using a mobile phone. In addition, 18.5% were involved in at least one road accident as a pedestrian in the last 5 years. Of the total number of registered accidents, 21% resulted in pedestrian injuries, 48.3% of which were serious. These were due to external causes not related to human factors or unidentified (58.5%) and behavior factors as a whole (41.4%, 31.5% of which were caused by pedestrians). Pearson's correlation coefficient showed evidence of a correlation between age and risk behaviors. Conclusions: All subjects in this study performed several risky actions as pedestrians, at least occasionally, and at least one fifth had been involved in a road accident as a pedestrian. It is known that the surroundings can positively or negatively influence individuals' behaviors; therefore, once prevention measures are identified, it is possible to influence risk behaviors. Therefore, road safety education and the physical environment must be considered together, and efforts focused on optimum infrastructure also need to consider road safety education.

A spatial analysis of urban transit accidents assisted by Emergency Mobile Care Services: an analysis of space and time

INTRODUCTION

Urban transit accident are a global public health problem. The objective of this study was to describe the profile of the victims and the occurrences of urban transit accidents attended to by emergency mobile care services (Serviço de Atendimento Móvel de Urgência- SAMU) in Recife, and their distribution based on spatial analysis.

METHODOLOGY

An ecological study, developed through secondary data from emergency mobile care services in Recife, referring to the total number of occurrences of urban transit accidents attended to from January 1 to June 30, 2015. The spatial analysis was performed using the Moran index.

RESULTS

Basic support units performed most of the emergency services (89.2%). Among the victims, there was a predominance of males (76.8%) and an age group of 20 - 29 years old (31.5%). Collisions were responsible for 59.9% of the transit accidents, and motorcycles for 61.6% of the accidents among all means of transportation. Friday was the day that showed the highest risk for treatment, and there was a concentration of events between 6:00 am - 8:59am and 6:00pm - 8:59pm. The MoranMap identified critical areas where calls came from traffic accidents during the period analyzed.

DISCUSSION

The records of the mobile service from the spatial analysis are an important source of information for health surveillance.

CONCLUSION

The spatial analysis of urban transit accidents identified regions with a positive spatial correlation, providing subsidies to the logistical planning of emergency mobile care services. This study is groundbreaking in that it offers such information about the region.

Representativity and univocity of traffic signs and their effect on trajectory movement in a driving-simulation task: Regulatory signs

INTRODUCTION

The effect of traffic signs in the motor behavior of drivers is not completely understood. Knowing how humans process the meaning of signs (not just by learning, but instinctively) will improve reaction time and decision making when traveling. The economic, social, and psychological consequences of car accidents are well studied. Every effort to find the solution of this social problem is encouraged.

METHOD

This study identifies which traffic signs are more ergonomic for participants, from a cognitive point of view, and determines, at the same time, their effect in participants' movement trajectory in a driving-simulation task: the tracking task.

RESULTS

The results point out that the signs least representative of their meaning produce a quantitative and qualitative different deviation from the center of the road than the most representative ones.

Representativity and univocity of traffic signs and their effect on trajectory movement in a driving simulation task: Warning signs

OBJECTIVE

The effect of traffic signs on the behavior of drivers is not completely understood. Knowing about how humans process the meaning of signs (not just by learning but instinctively) will improve reaction time and decision making when traveling. The economic, social, and psychological consequences of car accidents are well known.

METHODS

This study sounds out which traffic signs are more ergonomic for participants, from a cognitive point of view, and determines, at the same time, their effect in participants' movement trajectories in a driving simulation task.

RESULTS

Results point out that the signs least representative of their meaning produce a greater deviation from the center of the road than the most representative ones.

CONCLUSIONS

This study encourages both an in-depth analysis of the effect on movement of roadside signs and the study of how this effect can be modified by the context in which these signs are presented (with the aim to move the research closer to and analyze the data in real contexts). The goal is to achieve clarity of meaning and lack of counterproductive effects on the trajectory of representative signs (those that provoke fewer mistakes in the decision task).

An educational intervention in road safety among children and teenagers in Mexico

OBJECTIVE

The purpose of this article is to describe a public school-based educational intervention (EI) designed to increase knowledge, improve attitudes, and change practices related to road safety.

METHODS

We used a mixed-methods evaluation of a road traffic safety baseline diagnosis conducted in 4 public schools, 2 primary and 2 secondary. Research was organized into 4 phases: (1) diagnosis, (2) EI design, (3) implementation, and (4) evaluation. We used convenience sampling (n = 219 students) across schools and applied a pre-/posttest design based on quantitative and qualitative data. The former related to surveys on road safety experiences, knowledge, attitudes, and practice and the latter to observation checklists, community mapping, ethnography, and focus groups. To compare pre-post scores, we used multilevel mixed-effect ordinal logistic regressions. We developed data matrices, field notes, and systematized community mapping. We also transcribed focus group discussions, generated categories, and carried out thematic analysis.

RESULTS

Ethnography indicated poor sidewalk conditions, no helmet or seat belt use, overcrowded public transportation, and no traffic lights or proper signals. Pedestrians did not use sidewalks and crossed streets unsafely. Subsequent to the intervention, however, the study population showed significant changes in their knowledge, practices, and attitudes. They identified road traffic incidents (RTIs) as the first cause of death among children and youth, and most understood that the solution to the problem was incumbent upon each and every individual. They also displayed increased perceptions of danger in practices such as traveling on overcrowded public transportation, failing to wear seat belts in cars and helmets on motorcycles, crossing the street while using mobile phones or playing with friends, and riding with drunk drivers. Changes varied according to gender, and students reported being able to carry out safe practices only when they were in control of the situation; for instance, as pedestrians.

CONCLUSIONS

Because safe practices depend not only on children and youth but on the adults and social environment surrounding them, it is essential to engage parents, teachers, and decision makers in efforts to reduce RTIs. This will improve the establishment of commitments to impact social reality through consistent changes and mobilize greater resources for creating more secure communities in matters of road safety.

Regional disparities in road traffic injuries and their determinants in Brazil, 2013

BACKGROUND

In recent decades middle-income countries have experienced a rapid increase in the number of cars and motorcycles. Increased deaths and hospitalizations due to road traffic injuries (RTI) has been observed in several countries as a result. In this study we assessed the determinants of RTIs in Brazil by mode of transportation and compared differences in RTI rates among macro-regions.

METHODS

We used data from the National Health Survey (NHS) conducted in 2013 by the Brazilian Institute of Geography and Statistics and the Ministry of Health. NHS is a comprehensive household survey which includes a representative sample (N = 60,198) of individuals aged 18 years or older. The prevalence and determinants of RTI were estimated according to different modes of transport (car/van, motorcycle, and other) and regions of the country. Bivariate and multivariable logistic regression models were applied to assess crude and adjusted odds ratios, respectively, and their 95 % CI for RTI determinants.

RESULTS

The prevalence of RTI for the Southeast, South, Central-West, Northeast and North regions of Brazil was 2.4 %, 2.9 %, 4.4 %, 3.4 % and 4.8 %, respectively, pointing to important differences among regions. High percentages of motorcyclists were observed in the Northeast and North regions. For motorcyclists, factors associated with RTIs were being male (OR = 2.6;95 % CI:2.3;3.0), aged 18-29 (OR = 3.2; 95 % CI:2.7;3.8) and 30-39 years (OR = 2.0;95 % CI:1.7;2.5), black (OR = 1.4;95 % CI:1.1;1.7), having elementary educational (OR = 1.5;95 % CI:1.1;1.9), reporting binge drinking behavior (OR = 1.3;95 % CI:1.1;1.5), and living in the Central-West (OR = 2.0;95 % CI:1.6;2.5), Northeast (OR = 1.8;95 % CI:1.5;2.1) and North (OR = 2.0;95 % CI:1.6; 2.5) regions of the country. The independent variables associated with RTI for car/van occupants were being male (OR = 1.7;95 % CI:1.4;2.1), aged 18-29 (OR = 1.5;95 % CI:1.1;2.0) and 30-39 years (OR = 2.5;95 % CI:1.9;3.2), reporting binge drinking behavior (OR = 2.0;95 % CI:1.6;2.5) and living in the South region (OR = 1.6;95 % CI:1.3;2.1).

CONCLUSIONS

There were considerable regional disparities in RTI rates across Brazil's regions. Motorcyclists contributed to the high RTI rates in these regions as did demographic factors and behaviors such as alcohol use. These findings can help guide interventions to reduce the burden of RTIs in Brazil.

Early impact of a national multi-faceted road safety intervention program in Mexico: results of a time-series analysis

Background

In January 2008, a national multifaceted road safety intervention program (IMESEVI) funded by the Bloomberg Philanthropies was launched in Mexico. Two years later in 2010, IMESEVI was refocused as part of a 10-country international consortium demonstration project (IMESEVI/RS10). We evaluate the initial effects of each phase of the road safety intervention project on numbers of RT crashes, injuries and deaths in Mexico and in the two main target cities of Guadalajara-Zapopan and León.

Methods

An interrupted time series analysis using autoregressive integrated moving average (ARIMA) modeling was performed using monthly data of rates of RT crashes and injuries (police data), as well as deaths (mortality system data) from 1999–2011 with dummy variables representing each intervention phase.

Results

In the period following the first intervention phase at the country level and in the city of León, the rate of RT crashes decreased significantly (p<0.05). Notably, following the second intervention phase although there was no reduction at the country level, there has been a decrease in the RT crash rate in both Guadalajara-Zapopan (p = 0.029) and in León (p = 0.029). There were no significant differences in the RT injury or death rates following either intervention phase in either city.

Conclusion

These initial results suggest that a multi-faceted road safety intervention program appears to be effective in reducing road crashes in a middle-income country setting. Further analysis is needed to differentiate the effects of various interventions, and to determine what other economic and political factors might have affected this change.

[Mortality due to Road Traffic Accidents in Brazil in the last decade: trends and risk clusters]

OBJECTIVE

To analyze the temporal trends of mortality due to Road Traffic Accidents (RTA) as well as identify the existence and location of high risk death clusters for RTA using spatial analysis.

METHODOLOGY

Descriptive study of temporal trends by RTA, pedestrians, motorcyclists, motorists and passengers and spatial analysis for 2000 and 2010. The data was obtained from the Mortality Information System, and standardized rates were calculated by age in Brazilian states and municipalities grouped by population size.

RESULTS

The mortality rates due to RTA between 2000 and 2010 varied from 18 to 22.5 deaths/100,000 inhabitants. The risk of death for pedestrians decreased in recent years, though motorists, motorcyclists and passengers saw a rising trend. A higher risk of death by RTA occurred in municipalities with populations up to 20,000 inhabitants and in those from 20,000 to 100,000 inhabitants. Spatial analysis revealed risk clusters for RTA and motorcyclists and pillion riders with an increase between 2000 and 2010 and enlargement of the areas most at risk in the Northeast.

CONCLUSION

Increase in the rates of mortality by RTA mostly in the Northeast. Coordinated action between government, civil society and the citizens themselves is required to tackle this problem.

Large-scale road safety programmes in low- and middle-income countries: an opportunity to generate evidence

The growing burden of road traffic injuries, which kill over 1.2 million people yearly, falls mostly on low- and middle-income countries (LMICs). Despite this, evidence generation on the effectiveness of road safety interventions in LMIC settings remains scarce. This paper explores a scientific approach for evaluating road safety programmes in LMICs and introduces such a road safety multi-country initiative, the Road Safety in 10 Countries Project (RS-10). By building on existing evaluation frameworks, we develop a scientific approach for evaluating large-scale road safety programmes in LMIC settings. This also draws on '13 lessons' of large-scale programme evaluation: defining the evaluation scope; selecting study sites; maintaining objectivity; developing an impact model; utilising multiple data sources; using multiple analytic techniques; maximising external validity; ensuring an appropriate time frame; the importance of flexibility and a stepwise approach; continuous monitoring; providing feedback to implementers, policy-makers; promoting the uptake of evaluation results; and understanding evaluation costs. The use of relatively new approaches for evaluation of real-world programmes allows for the production of relevant knowledge. The RS-10 project affords an important opportunity to scientifically test these approaches for a real-world, large-scale road safety evaluation and generate new knowledge for the field of road safety.

Nonfatal road traffic injuries: can road safety campaigns prevent hazardous behavior? An Italian experience

OBJECTIVES

Road traffic injuries are a widespread problem and are very difficult to prevent. The purpose of this study was to verify whether intensive versus basic road safety education programs are associated with different incidence and severity of nonfatal road injuries.

METHOD

The study had an ecological design and involved Local Health Authority One (LHA1) in Salerno, Italy, which includes 20 municipalities. Data on nonfatal road injuries occurring in the periods June to August 2003 and June to August 2008 were obtained from trained operators through the information system of the emergency department. All 20 municipalities received a basic community road safety education program (publicity campaign using bill-posting, brochures, mass media communication with press conferences, articles in local papers, radio and television interviews, and a dedicated LHA1 web site), and 12 municipalities also received an intensive education campaign (in secondary schools, community conferences, and activities organized by police and firefighters). The incidence and severity of nonfatal road traffic injuries were compared between June to August 2003 (before the campaign) and June to August 2008.

RESULTS

The total number of injuries in all 20 municipalities in 2003 and 2008 was 907 and 755, respectively. The incidence of injuries decreased in the study period both in the 8 municipalities where only the basic campaign was run (difference in incidence = -0.4; P = .053) and in the 12 municipalities where the intensive campaign was implemented (difference in incidence = -0.5; P < .001); focusing on severity, the incidence of severe injuries decreased or remained the same in the study period in the 2 studied group.

DISCUSSION

The results are coherent with other European studies and show that an overall downward trend exists but is presumably not a direct consequence of road safety education. This does not mean that such campaigns are useless (they are important to raise awareness) but that they should be supplemented with complementary activities in order to be really effective.

Cost savings associated with 10 years of road safety policies in Catalonia, Spain

OBJECTIVE

To determine whether the road safety policies introduced between 2000 and 2010 in Catalonia, Spain, which aimed primarily to reduce deaths from road traffic collisions by 50% by 2010, were associated with economic benefits to society.

METHODS

A cost analysis was performed from a societal perspective with a 10-year time horizon. It considered the costs of: hospital admissions; ambulance transport; autopsies; specialized health care; police, firefighter and roadside assistance; adapting to disability; and productivity lost due to institutionalization, death or sick leave of the injured or their caregivers; as well as material and administrative costs. Data were obtained from a Catalan hospital registry, the Catalan Traffic Service information system, insurance companies and other sources. All costs were calculated in euros (€) at 2011 values.

FINDINGS

A substantial reduction in deaths from road traffic collisions was observed between 2000 and 2010. Between 2001 and 2010, with the implementation of new road safety policies, there were 26 063 fewer road traffic collisions with victims than expected, 2909 fewer deaths (57%) and 25 444 fewer hospitalizations. The estimated total cost savings were around €18 000 million. Of these, around 97% resulted from reductions in lost productivity. Of the remaining cost savings, 63% were associated with specialized health care, 15% with adapting to disability and 8.1% with hospital care.

CONCLUSION

The road safety policies implemented in Catalonia in recent years were associated with a reduction in the number of deaths and injuries from traffic collisions and with substantial economic benefits to society.

Comparing the impact of socio-demographic factors associated with traffic injury among older road users and the general population in Japan

BACKGROUND

The increasing number of older road users represents a public health issue because older individuals are more susceptible to traffic injury and mortality than the general population. This study investigated the association between socio-demographic factors and traffic injury and traffic mortality for the general population and among older road users in Japan.

METHODS

An ecological study was conducted using national data in Japan. Multivariate regression methods were applied to investigate the association of traffic injury and traffic mortality for the general population and among older road users with significant demographic, economic, road traffic, and medical/cultural factors.

RESULTS

Income per capita, total road length, and alcohol consumption per person were significantly associated with traffic injury and traffic mortality both for the general population and among older road users in Japan. Income per capita and alcohol consumption per person were negatively associated with traffic mortality for both groups. Meanwhile, for both groups, income per capita was positively associated with traffic injury, while total road length and alcohol consumption per person were negatively associated with traffic injury.

CONCLUSIONS

The effects of socio-demographic factors on traffic injury and traffic mortality in Japan were similar for both the general population and older road users. The study results suggest that injury preventive measures designed for the general population will be beneficial also for older road users in Japan.

Acidentes de trânsito no Brasil de 1998 a 2010: muitas mudanças e poucos resultados

O artigo descreve a situação dos acidentes de trânsito no Brasil, desde a implementação do Código de Trânsito Brasileiro de 1998 até o ano de 2010. Foi realizada análise dos principais trabalhos científicos e publicações não acadêmicas nacionais. A revisão de literatura incluiu periódicos indexados, não indexados, relatórios técnicos, busca específica por autores, referências bibliográficas de artigos e contato com pesquisadores. Os principais problemas do trânsito brasileiro identificados foram aumento do número absoluto de mortos e das taxas de mortalidade, ampliação da frota de motocicletas e o uso de álcool. Foram identificados autores influentes e ilhas de produção de conhecimento nas áreas pesquisadas. Os autores apresentam algumas possíveis soluções e sugerem que o poder público não tem assumido a responsabilidade que lhe cabe no controle e redução dos acidentes de trânsito.

Intervenção comunitária para prevenção de acidentes de trânsito entre trabalhadores ciclistas

OBJETIVO: Avaliar uma intervenção educacional de prevenção de acidentes de trânsito com trabalhadores que utilizam a bicicleta como modo de transporte. MÉTODOS: Estudo de intervenção, longitudinal, com implementação escalonada, realizado em cinco bairros com características geográficas distintas na cidade de Pelotas, RS, de janeiro de 2006 a maio de 2007. Foram sorteados 42 setores censitários desses bairros. Todos os domicílios foram visitados em busca de trabalhadores do sexo masculino que utilizassem a bicicleta como modo de transporte, resultando em uma amostra de 1.133 indivíduos. Foram analisados como desfechos "acidentes de trânsito" e de "quase-acidentes". Mensalmente, via telefone, os ciclistas eram questionados a respeito da ocorrência de acidentes de trânsito e de "quase-acidentes". Quinzenalmente, a partir do segundo mês de acompanhamento, um grupo de aproximadamente 60 ciclistas era convidado a participar da intervenção, que incluía um componente educativo (palestra e apresentação de vídeo educativo), distribuição de um kit de segurança (colete noturno refletivo, cartilha educativa e fitas refletivas) e revisão dos freios da bicicleta (manutenção realizada se necessário). Regressão de Poisson, com ajuste para o efeito do tempo, foi utilizada para medir o efeito da intervenção. RESULTADOS: Aproximadamente 45% dos ciclistas não compareceram à intervenção. Durante o período do estudo, 9% dos indivíduos informaram um acidente de trânsito e 88%, um quase-acidente. No total, ocorreram 106 acidentes e 1.091 quase-acidentes. Não foi observado efeito da intervenção em ambos os desfechos. CONCLUSÕES: A intervenção proposta não foi capaz de reduzir acidentes entre trabalhadores ciclistas. Falta de interesse em segurança por parte dos ciclistas e fatores externos, tais como infra-estrutura das vias e comportamento dos motoristas, podem ter colaborado para esse resultado.