 Education efforts can be measured by changes in knowledge, attitudes, beliefs and behaviors, before and after the intervention, however tying these changes back into reductions in morbidity and mortality is often problematic.Examining trends in morbidity and mortality in the population is usually not difficult and may provide some indication of the effectiveness of injury prevention interventions.However, this approach suffers from the potential of ecological fallacy, where the data shows an association between an intervention and a change in the outcome, but there is actually no causal relationship.