Road traffic accidents represent a significant global health problem, costing countries 1–2% of their GDP. Despite the high number of annual fatalities and injuries worldwide (over 1.3 million deaths annually, with road accidents being the leading cause of death for 5–29-year-olds), societal awareness and preventative action remain insufficient. While measures such as road improvements, stricter traffic regulations, and improved vehicle safety exist, road safety education is crucial, particularly in schools, to cultivate safe driving habits from a young age. Although the effectiveness of school-based campaigns is not always extensively studied or directly correlated with accident prevention, it is vital for establishing healthy attitudes and behaviors. Many countries implement prevention campaigns, but the effectiveness in preventing future accidents is often not measured. This study focuses on evaluating the knowledge gained from a specific road safety campaign delivered by AESLEME (Association for the Study of Spinal Cord Injuries), a non-profit NGO dedicated to road safety education and support for victims. AESLEME's instructors, including healthcare workers and individuals with spinal cord injuries from road accidents, use personal stories to enhance their presentations, creating a more impactful learning experience aligned with Protection Motivation Theory, which emphasizes the importance of risk perception, severity, and vulnerability.

The literature review cites several studies examining the effectiveness of school-based driver education programs in preventing traffic crashes (Ian R, Irene K, Cochrane Injuries Group Driver Education Reviewers, 2001; Elder RW et al., 2005; Simons-Morton BG et al., 2012; Novoa AM et al., 2009; Mohan D, 2003; Petridou E, Moustaki M, 2000). These studies highlight the varied approaches used in road safety campaigns worldwide, including those emphasizing deterrence (fines) and those focused on raising awareness and promoting preventative behavior. The literature also touches upon the challenges in measuring the long-term impact of school-based campaigns on accident reduction and the complexity of assessing attitudinal changes in relation to future accident involvement (Alonso F et al., 2018). The effectiveness of school campaigns remains a topic of debate, with some research suggesting that increased knowledge does not necessarily translate to improved behavior (Zeedyk MS et al., 2001). Other factors, such as parental influence and peer pressure, play significant roles in shaping driving behaviors (Taubman-Ben-Ari O et al., 2014; Mehdizadeh M et al., 2017). However, studies also demonstrate a positive correlation between knowledge of traffic rules and safer road behaviors (Dong X et al., 2011; Cuenen A et al., 2016; Trifunovic A et al., 2017; Jafarpour S, Rahimi-Movaghar V, 2014; Hatfield J, Fernandes R, 2009; Guggenheim N, Taubman-Ben-Ari O, 2018; Alonso F et al., 2016).

This quasi-experimental pre- and post-intervention study involved 8106 students aged 12–14 from various schools and high schools across Spain. Participation required signed consent from both schools and parents. A convenience sample was used based on accessibility and willingness to participate. Two identical multiple-choice tests, approved by the Directorate-General for Traffic, were administered to each student. Each test contained 12 questions with only one correct answer per question. The first test was given before an AESLEME road safety presentation (lasting 1–1.5 hours), and the second test was administered one month later. The presentation included interactive elements, epidemiological data on road accidents, descriptions of potential irreversible injuries, and personal testimonials from instructors with spinal cord injuries caused by road accidents. Data analysis was conducted using the StatCalc program (Epi Info, CDC) to compare the number of correct answers before and after the intervention, stratified by region and nationally. Chi-squared tests, odds ratios (OR), and 95% confidence intervals (CI) were calculated to assess the statistical significance of the changes in the number of correct answers.

The study analyzed the responses of 8106 students. Table 1 presents the percentage of students answering correctly before and after the presentation, categorized by the number of correct answers and stratified by region. Table 2 shows the statistical significance and increase in correct answers after the presentation. Overall, there was a statistically significant (p < 0.01) increase in correct answers nationally. This increase represents a 61% rise in the probability of correct answers (95% CI: 53% to 64%). Regional variations were observed, ranging from an 8% increase in the Canary Islands to a 278% increase in Andalusia. Other regions showed significant increases: Aragon (89%), Castilla la Mancha and Madrid (241%), Extremadura (126%), and the Basque Country (68%). Figure 1 visually displays the percentage of students with 7–12 correct answers before and after the presentation for different regions, illustrating the significant increase after the intervention.

The study's results demonstrate the effectiveness of AESLEME's road safety education program in improving students' knowledge of road safety. The statistically significant increase in correct answers across all regions suggests the program's impact is robust and not limited to specific geographic areas. The use of personal testimonials and interactive elements in the presentation likely contributed to the program's effectiveness, aligning with the Protection Motivation Theory. While the study focused on knowledge acquisition, the significant improvements suggest a potential for behavioral changes towards increased road safety. Although a long-term study following participants to assess actual behavior change is needed, other studies mentioned support a positive association between increased knowledge of traffic rules, risk perception, and safer driving behaviors. The variation in the degree of effectiveness across regions might be attributed to factors such as the level of engagement from participating schools or students. The method, proven reliable and consistent across different regions and instructors, highlights the value of the chosen approach.

This study provides strong evidence for the effectiveness of AESLEME's school-based road safety program in increasing knowledge among adolescents. The statistically significant increase in correct answers, ranging from 8% to 278% across regions, highlights the program's impact. Further research could investigate the long-term effects on driving behavior and explore potential program adaptations for wider applicability.

The study's design, ensuring anonymity, prevented individual-level analysis of before-and-after responses, limiting the depth of statistical analysis. The convenience sampling method may also limit the generalizability of the findings to other populations or regions where the program was not implemented. It is also crucial to acknowledge that increased knowledge does not guarantee a direct translation into improved road safety behaviors in the long-term. Future research, including longitudinal studies tracking participants' behaviors, is needed to fully assess the impact of this program on accident prevention.