BACKGROUND Despite education and changes in public policy, trauma-related injuries continue to exact an unacceptably high morbidity and mortality, particularly among young people. Most injuries are preventable and can often be attributed to poor choices. METHODS A mixed methods study involving 262 high school students was conducted to study the effect on knowledge and risk assessment after a day-long injury prevention program, and to develop a theoretic framework to better understand attitudes and beliefs that underlie commonly seen behaviors among young people. RESULTS Knowledge about injury increased after participation in the program, but was not durable over time. Risk perception and capacity to discern safer options improved after the program and persisted for up to 30 days. A qualitative analysis revealed seven themes that reflect a sense of invincibility and a belief that fate is more important than choice in determining the outcomes of a situation. CONCLUSIONS Effective injury prevention programs should include risk perception training that is informed by the attitudes and beliefs of the recipients.