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Trifunović A, Pešić D, Čičević S, Antić B. The importance of spatial orientation and knowledge of traffic signs for children's traffic safety. ACCIDENT; ANALYSIS AND PREVENTION 2017; 102:81-92. [PMID: 28273551 DOI: 10.1016/j.aap.2017.02.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 01/18/2017] [Accepted: 02/21/2017] [Indexed: 06/06/2023]
Abstract
Pre-school children, as well as children from lower grades in primary school, who although rarely, completely independently participate in traffic, represent a vulnerable population from the standpoint of traffic safety. The greatest number of children were injured or killed in road traffic crashes on their way from home to kindergarten or school. Mostly due to lack of experience, children's behavior is confusing and often reckless and hasty. Safe behavior in the traffic environment demands certain cognitive skills. Unlike adults, children have less than fully developed peripheral vision. Also, changes occur in color perception, i.e. discrimination. All this leads to the conclusion that the stage of physical and mental development of the child is very important for safe participation in traffic. So, to estimate if they are sufficiently equipped to participate safely in traffic, a sensitive test for young children that may be suitable for their level of cognitive development is required. Accordingly, road safety education should be arranged in such a way that considers the child's level of development, as has been shown to be more effective when started at younger ages. Play is the most natural and easiest way of learning because it is the lens through which children experience their world, and the world of others. Having this in mind, if we want to measure the abilities of a child, and their preparedness for safety participation in traffic, unavoidable is to use non-verbal tests. The purpose of this study is to explore primary schooler's spatial, and abilities of color perception and memorization, as well as their performances in interpreting the meaning of traffic signs. In addition, neighborhood environmental correlates (rural-urban) and possible individual differences influences on the relationship among these abilities was examined. Knowledge about these factors affecting children's safety can be applied to improve relevant intervention measures for promoting safe participation of young children in traffic. It may constitute the basis for effective classroom work which implies the creation of individualized educational plans and programs, through which road safety skills could be acquired and adopted through play.
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Affiliation(s)
- Aleksandar Trifunović
- University of Belgrade, Faculty of Transport and Traffic Engineering, Vojvode Stepe 305, 11000 Belgrade, Serbia.
| | - Dalibor Pešić
- University of Belgrade, Faculty of Transport and Traffic Engineering, Vojvode Stepe 305, 11000 Belgrade, Serbia.
| | - Svetlana Čičević
- University of Belgrade, Faculty of Transport and Traffic Engineering, Vojvode Stepe 305, 11000 Belgrade, Serbia.
| | - Boris Antić
- University of Belgrade, Faculty of Transport and Traffic Engineering, Vojvode Stepe 305, 11000 Belgrade, Serbia.
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Ben-Bassat T, Avnieli S. The effect of a road safety educational program for kindergarten children on their parents' behavior and knowledge. ACCIDENT; ANALYSIS AND PREVENTION 2016; 95:78-85. [PMID: 27410175 DOI: 10.1016/j.aap.2016.06.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 04/16/2016] [Accepted: 06/23/2016] [Indexed: 06/06/2023]
Abstract
Road safety education for children is one of the most important means for raising awareness of road safety and for educating children to behave safely as pedestrians, bicycle riders, and vehicle passengers. The current research presents a novel attempt to examine the effect of a unique road safety educational program for kindergarten children on a secondary target group-the parents. The program, named the "Zahav Bagan" program (ZBP), is presented at kindergartens once a week during the entire academic year. It is conducted by senior citizen volunteers and is part of the formal education of the children. The main purpose of the current study was to compare the behavior, awareness, and knowledge about child road safety, of two groups of parents-those whose children participated in the ZBP group, and those whose children did not; this latter group was the control group. A telephone-based survey was conducted using a sample of 76 ZBP parents and 59 control group parents. Results of the survey showed no effect of ZBP on parents' knowledge of child road safety law and recommendations, but more importantly, the results did show a significant effect in terms of parents' observance of safe behavior and in their awareness of road safety in everyday life. These results confirm the importance of educational programs on road safety, especially as triggers and reminders to children and to their parents, to act as cautious road users.
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Affiliation(s)
- Tamar Ben-Bassat
- Shamoon College of Engineering, Department of Industrial Engineering and Management, 84 Jabotinski St., Ashdod 77245, Israel.
| | - Shani Avnieli
- Ben Gurion University of the Negev, Department of Industrial Engineering and Management, P.O.B. 653, Beer Sheva 84105, Israel.
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Stevenson M, Sleet D, Ferguson R. Preventing Child Pedestrian Injury: A Guide for Practitioners. Am J Lifestyle Med 2015; 9:442-450. [PMID: 31762716 PMCID: PMC6873923 DOI: 10.1177/1559827615569699] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Each year, an estimated 270,000 pedestrians die from road traffic-related injuries, (worldwide) and children are among the most vulnerable. Child pedestrian injuries occur primarily in residential areas, often on the same street or in close proximity to the child's home, and 90% of injured child pedestrians are unaccompanied by an adult at the time of the injury. The cause of these injuries is a complex combination of factors related not only to characteristics of the child but also the built environment, the road configuration, features of the motor vehicle that might reduce injury, and driver behavior. Accordingly, effective interventions must incorporate education, technology, and improved infrastructure. The medical practitioner can not only provide the necessary education but can also be a powerful voice for changes in pedestrian infrastructure that make walking safer. This article explores the current state of childhood pedestrian injuries using examples from the United States and Australia. Pedestrian interventions and the role that primary care and lifestyle practitioners play in promoting safe pedestrian behaviors among their patients and their families are discussed.
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Affiliation(s)
- Mark Stevenson
- Monash University, Clayton, Melbourne, Victoria, Australia
| | - David Sleet
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Morrongiello BA, Corbett M, Milanovic M, Beer J. Using a Virtual Environment to Examine How Children Cross Streets: Advancing Our Understanding of How Injury Risk Arises. J Pediatr Psychol 2015; 41:265-75. [PMID: 26338980 DOI: 10.1093/jpepsy/jsv078] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 07/31/2015] [Indexed: 11/14/2022] Open
Abstract
PURPOSE To examine how risk of injury can arise for child pedestrians. METHODS Using a highly immersive virtual reality system interfaced with a 3-D movement measurement system, younger (M = 8 years) and older (M = 10 years) children's crossing behaviors were measured under conditions that introduced variation in vehicle speed, distance, and intervehicle gaps. RESULTS Children used distance cues in deciding when to cross; there were no age or sex differences. This increased risk of injury in larger intervehicle gaps because they started late and did not monitor traffic or adjust walking speed as they crossed. In contrast, injury risk in smaller intervehicle gaps of equal risk (i.e., same time to contact) occurred because crossing behavioral adjustments (starting early, increasing walking speed while crossing) were not sufficient. CONCLUSIONS Dependence on distance cues increases children's risk of injury as pedestrians when crossing in a variety of traffic situations.
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Shen J, McClure LA, Schwebel DC. Relations between temperamental fear and risky pedestrian behavior. ACCIDENT; ANALYSIS AND PREVENTION 2015; 80:178-184. [PMID: 25912314 PMCID: PMC10402914 DOI: 10.1016/j.aap.2015.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 04/08/2015] [Accepted: 04/12/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Child pedestrian injury poses a significant global public health challenge. This study examines relations between temperamental fear and children's risky pedestrian behavior, utilizing mediation analytic strategies to study underlying mechanisms of the hypothesized relation. METHODS As part of a larger study, 240 seven- and eight-year-old children completed 30 crossings in a virtual reality (VR) pedestrian environment. Three pedestrian behaviors were considered: start gap (lag after a traffic gap appears before child initiates crossing into the gap), time to contact (TTC; gap between avatar and the lead oncoming vehicle), and hits (collisions with vehicles in simulated crossings). Temperamental fear was measured by parent report. RESULTS Fearful children were more likely to be struck by virtual vehicles, and the relation between fear and risky pedestrian behaviors was mediated by start gap and TTC. Specifically, children who were temperamentally more fearful were more likely to hesitate before initiating crossing, which led to shorter gaps between themselves and the oncoming vehicle, hence causing them to be more likely to be hit by virtual vehicles. Gender interacted with fear, such that fearful girls were most likely to be hit. CONCLUSIONS Both temperamental fear and gender influenced the risk of child pedestrian injuries. Delayed entry into traffic and shorter gaps between children and oncoming vehicles may underlie this relation. Future research should explore how these factors might influence the effectiveness of prevention programs.
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Affiliation(s)
- Jiabin Shen
- Department of Psychology, University of Alabama, Birmingham, USA.
| | - Leslie A McClure
- Department of Biostatistics, University of Alabama, Birmingham, USA
| | - David C Schwebel
- Department of Psychology, University of Alabama, Birmingham, USA
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Morrongiello BA, Corbett M. Using a virtual environment to study child pedestrian behaviours: a comparison of parents’ expectations and children's street crossing behaviour. Inj Prev 2015; 21:291-5. [DOI: 10.1136/injuryprev-2014-041508] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 03/08/2015] [Indexed: 11/03/2022]
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Avis KT, Gamble KL, Schwebel DC. Obstructive sleep apnea syndrome increases pedestrian injury risk in children. J Pediatr 2015; 166:109-14. [PMID: 25444002 PMCID: PMC4274212 DOI: 10.1016/j.jpeds.2014.09.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 08/11/2014] [Accepted: 09/18/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate pedestrian behavior, including reaction time, impulsivity, risk-taking, attention, and decision-making, in children with obstructive sleep apnea syndrome (OSAS) compared with healthy controls. STUDY DESIGN Using a case control design, 8- to 16-year-olds (n = 60) with newly diagnosed and untreated OSAS engaged in a virtual reality pedestrian environment. Sixty-one healthy children matched using a yoke-control procedure by age, race, sex, and household income served as controls. RESULTS Children with OSAS were riskier pedestrians than healthy children of the same age, race, and sex. Children with OSAS waited less time to cross (P < .01). The groups did not differ in looking at oncoming traffic or taking longer to decide to cross. CONCLUSIONS Results suggest OSAS may have significant consequences on children's daytime functioning in a critical domain of personal safety, pedestrian skills. Children with OSAS appeared to have greater impulsivity when crossing streets. Results highlight the need for heightened awareness of the consequences of untreated sleep disorders and identify a possible target for pediatric injury prevention.
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Affiliation(s)
- Kristin T Avis
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL.
| | - Karen L Gamble
- Department of Psychiatry, University of Alabama at Birmingham, Birmingham, AL
| | - David C Schwebel
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL
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Pollack KM, Gielen AC, Mohd Ismail MN, Mitzner M, Wu M, Links JM. Investigating and improving pedestrian safety in an urban environment. Inj Epidemiol 2014; 1:11. [PMID: 27747673 PMCID: PMC5005641 DOI: 10.1186/2197-1714-1-11] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 02/18/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prompted by a series of fatal and nonfatal pedestrian-vehicle collisions, university leadership from one urban institution collaborated with its academic injury research center to investigate traffic-related hazards facing pedestrians. METHODS This descriptive epidemiologic study used multiple data collection strategies to determine the burden of pedestrian injury in the target area. Data were collected in 2011 through a review of university crash reports from campus police; a systematic environmental audit and direct observations using a validated instrument and trained raters; and focus groups with faculty, students, and staff. Study findings were synthesized and evidence-informed recommendations were developed and disseminated to university leadership. RESULTS Crash reports provided some indication of the risks on the streets adjacent to the campus. The environmental audit identified a lack of signage posting the speed limit, faded crosswalks, issues with traffic light and walk sign synchronization, and limited formal pedestrian crossings, which led to jaywalking. Focus groups participants described dangerous locations and times, signal controls and signage, enforcement of traffic laws, use of cell phones and iPods, and awareness of pedestrian safety. Recommendations to improve pedestrian safety were developed in accordance with the three E's of injury prevention (education, enforcement, and engineering), and along with plans for implementation and evaluation, were presented to university leadership. CONCLUSIONS These results underscore the importance of using multiple methods to understand fully the problem, developing pragmatic recommendations that align with the three E's of injury prevention, and collaborating with leadership who have the authority to implement recommended injury countermeasures. These lessons are relevant for the many colleges and universities in urban settings where a majority of travel to offices, classrooms, and surrounding amenities are by foot.
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Affiliation(s)
- Keshia M Pollack
- Department of Health Policy and Management, Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
| | - Andrea C Gielen
- Department of Health, Behavior and Society, Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Mohd Nasir Mohd Ismail
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Molly Mitzner
- Johns Hopkins Bloomberg School of Public Health Diversity Summer Internship Program, Baltimore, MD, 21205, USA
| | - Michael Wu
- Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Jonathan M Links
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
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Schwebel DC, McClure LA, Severson J. Teaching children to cross streets safely: a randomized, controlled trial. Health Psychol 2014; 33:628-38. [PMID: 24447187 PMCID: PMC4101996 DOI: 10.1037/hea0000032] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Child pedestrian injury is a global public health challenge. This randomized, controlled trial considered comparative efficacy of individualized streetside training, training in a virtual pedestrian environment, training using videos and Web sites, plus no-training control, to improve children's street-crossing ability. METHODS Pedestrian safety was evaluated among 231 7- and 8-year-olds using both streetside (field) and laboratory-based (virtual environment) trials before intervention group assignment, immediately posttraining, and 6 months posttraining. All training groups received 6 30-min sessions. Four outcomes assessed pedestrian safety: start delay (temporal lag before initiating crossing), hits/close calls (collisions/near-misses with vehicles in simulated crossings), attention to traffic (looks left and right, controlled for time), and missed opportunities (safe crossing opportunities that were missed). RESULTS Results showed training in the virtual pedestrian environment and especially individualized streetside training resulted in safer pedestrian behavior postintervention and at follow-up. As examples, children trained streetside entered safe traffic gaps more quickly posttraining than control group children and children trained streetside or in the virtual environment had somewhat fewer hits/close calls in postintervention VR trials. Children showed minimal change in attention to traffic posttraining. Children trained with videos/websites showed minimal learning. CONCLUSION Both individualized streetside training and training within virtual pedestrian environments may improve 7- and 8-year-olds' street-crossing safety. Individualized training has limitations of adult time and labor. Virtual environment training has limitations of accessibility and cost. Given the public health burden of child pedestrian injuries, future research should explore innovative strategies for effective training that can be broadly disseminated.
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Randomized controlled trial to evaluate the effectiveness of a video game as a child pedestrian educational tool. J Trauma Acute Care Surg 2014; 76:1317-21. [PMID: 24747467 DOI: 10.1097/ta.0000000000000217] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Injury is the number one cause of death and disability in children in the United States and an increasingly important public health problem globally. While prevention of injuries is an important goal, prevention efforts are currently fragmented, poorly funded, and rarely studied. Among school-aged children, pedestrian crashes are a major mechanism of injury. We hypothesized that we could develop a game-based educational tool that would be effective in teaching elementary school children the principles of pedestrian safety. METHODS Between November 2011 and June 2013, second- and third-grade children in Los Angeles Unified School District were randomly assigned to play a unique interactive video game (Ace's Adventure) about pedestrian safety or to a traditional didactic session about pedestrian safety. A pretest and posttest were administered to the study participants. Afterward, study participants were observed for appropriate pedestrian behavior on a simulated street set called Street Smarts. All statistical analyses were performed using SAS version 9.2. RESULTS A total of 348 study participants took the pretest and posttest. There were 180 who were randomized to the didactic and 168 who were randomized to the video game. The didactic group demonstrated a higher mean score increase (1.01, p < 0.0001) as compared with the video game group (0.44, p < 0.0001). However, observation of study participants revealed that participants who played the video game, as compared with the didactic group, more frequently exhibited appropriate behavior during the following: exiting a parked car (p = 0.01), signaling to a car that was backing up (p = 0.01), signaling to a stopped car (p = 0.0002), and crossing the street (p = 0.01). CONCLUSION Students who played the educational video game about pedestrian safety performed similarly to those who attended a more traditional and labor-intensive didactic learning. Innovative educational methods, such as game playing, could significantly change our approach to injury prevention and have the potential to decrease the burden of injury among children worldwide.
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Schwebel DC, McClure LA. Training children in pedestrian safety: distinguishing gains in knowledge from gains in safe behavior. J Prim Prev 2014; 35:151-62. [PMID: 24573688 PMCID: PMC4005841 DOI: 10.1007/s10935-014-0341-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Pedestrian injuries contribute greatly to child morbidity and mortality. Recent evidence suggests that training within virtual pedestrian environments may improve children's street crossing skills, but may not convey knowledge about safety in street environments. We hypothesized that (a) children will gain pedestrian safety knowledge via videos/software/internet websites, but not when trained by virtual pedestrian environment or other strategies; (b) pedestrian safety knowledge will be associated with safe pedestrian behavior both before and after training; and (c) increases in knowledge will be associated with increases in safe behavior among children trained individually at streetside locations, but not those trained by means of other strategies. We analyzed data from a randomized controlled trial evaluating pedestrian safety training. We randomly assigned 240 children ages 7-8 to one of four training conditions: videos/software/internet, virtual reality (VR), individualized streetside instruction, or a no-contact control. Both virtual and field simulations of street crossing at 2-lane bi-directional mid-block locations assessed pedestrian behavior at baseline, post-training, and 6-month follow-up. Pedestrian knowledge was assessed orally on all three occasions. Children trained by videos/software/internet, and those trained individually, showed increased knowledge following training relative to children in the other groups (ps < 0.01). Correlations between pedestrian safety knowledge and pedestrian behavior were mostly non-significant. Correlations between change in knowledge and change in behavior from pre- to post-intervention also were non-significant, both for the full sample and within conditions. Children trained using videos/software/internet gained knowledge but did not change their behavior. Children trained individually gained in both knowledge and safer behavior. Children trained virtually gained in safer behavior but not knowledge. If VR is used for training, tools like videos/internet might effectively supplement training. We discovered few associations between knowledge and behavior, and none between changes in knowledge and behavior. Pedestrian safety knowledge and safe pedestrian behavior may be orthogonal constructs that should be considered independently for research and training purposes.
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Affiliation(s)
- David C Schwebel
- Department of Psychology, University of Alabama at Birmingham, 1300 University Blvd, CH 415, Birmingham, AL, 35294, USA,
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Schwebel DC, Barton BK, Shen J, Wells HL, Bogar A, Heath G, McCullough D. Systematic review and meta-analysis of behavioral interventions to improve child pedestrian safety. J Pediatr Psychol 2014; 39:826-45. [PMID: 24864275 DOI: 10.1093/jpepsy/jsu024] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Pedestrian injuries represent a pediatric public health challenge. This systematic review/meta-analysis evaluated behavioral interventions to teach children pedestrian safety. METHODS Multiple strategies derived eligible manuscripts (published before April 1, 2013, randomized design, evaluated behavioral child pedestrian safety interventions). Screening 1,951 abstracts yielded 125 full-text retrievals. 25 were retained for data extraction, and 6 were later omitted due to insufficient data. In all, 19 articles reporting 25 studies were included. Risk of bias and quality of evidence were assessed. RESULTS Behavioral interventions generally improve children's pedestrian safety, both immediately after training and at follow-up several months later. Quality of the evidence was low to moderate. Available evidence suggested interventions targeting dash-out prevention, crossing at parked cars, and selecting safe routes across intersections were effective. Individualized/small-group training for children was the most effective training strategy based on available evidence. CONCLUSIONS Behaviorally based interventions improve children's pedestrian safety. Efforts should continue to develop creative, cost-efficient, and effective interventions.
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Affiliation(s)
- David C Schwebel
- Department of Psychology, University of Alabama at Birmingham and Department of Psychology and Communication Studies, University of Idaho
| | - Benjamin K Barton
- Department of Psychology, University of Alabama at Birmingham and Department of Psychology and Communication Studies, University of Idaho
| | - Jiabin Shen
- Department of Psychology, University of Alabama at Birmingham and Department of Psychology and Communication Studies, University of Idaho
| | - Hayley L Wells
- Department of Psychology, University of Alabama at Birmingham and Department of Psychology and Communication Studies, University of Idaho
| | - Ashley Bogar
- Department of Psychology, University of Alabama at Birmingham and Department of Psychology and Communication Studies, University of Idaho
| | - Gretchen Heath
- Department of Psychology, University of Alabama at Birmingham and Department of Psychology and Communication Studies, University of Idaho
| | - David McCullough
- Department of Psychology, University of Alabama at Birmingham and Department of Psychology and Communication Studies, University of Idaho
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Schwebel DC, McClure LA, Severson J. Usability and Feasibility of an Internet-Based Virtual Pedestrian Environment to Teach Children to Cross Streets Safely. VIRTUAL REALITY 2014; 18:5-11. [PMID: 24678263 PMCID: PMC3963181 DOI: 10.1007/s10055-013-0238-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Child pedestrian injury is a preventable global health challenge. Successful training efforts focused on child behavior, including individualized streetside training and training in large virtual pedestrian environments, are laborious and expensive. This study considers the usability and feasibility of a virtual pedestrian environment "game" application to teach children safe street-crossing behavior via the internet, a medium that could be broadly disseminated at low cost. Ten 7- and 8-year-old children participated. They engaged in an internet-based virtual pedestrian environment and completed a brief assessment survey. Researchers rated children's behavior while engaged in the game. Both self-report and researcher observations indicated the internet-based system was readily used by the children without adult support. The youth understood how to engage in the system and used it independently and attentively. The program also was feasible. It provided multiple measures of pedestrian safety that could be used for research or training purposes. Finally, the program was rated by children as engaging and educational. Researcher ratings suggested children used the program with minimal fidgeting or boredom. The pilot test suggests an internet-based virtual pedestrian environment offers a usable, feasible, engaging, and educational environment for child pedestrian safety training. If future research finds children learn the cognitive and perceptual skills needed to cross streets safely within it, internet-based training may provide a low-cost medium to broadly disseminate child pedestrian safety training. The concept may be generalized to other domains of health-related functioning such as teen driving safety, adolescent sexual risk-taking, and adolescent substance use.
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Abstract
STUDY OBJECTIVES Many cognitive factors contribute to unintentional pedestrian injury, including reaction time, impulsivity, risk-taking, attention, and decision-making. These same factors are negatively influenced by excessive daytime sleepiness (EDS), which may place children with EDS at greater risk for pedestrian injury. DESIGN PARTICIPANTS AND METHODS Using a case-control design, 33 children age 8 to 16 y with EDS from an established diagnosis of narcolepsy or idiopathic hypersomnia (IHS) engaged in a virtual reality pedestrian environment while unmedicated. Thirty-three healthy children matched by age, race, sex, and household income served as controls. RESULTS Children with EDS were riskier pedestrians than healthy children. They were twice as likely to be struck by a virtual vehicle in the virtual pedestrian environment than healthy controls. Attentional skills of looking at oncoming traffic were not impaired among children with EDS, but decision-making for when to cross the street safely was significantly impaired. CONCLUSIONS Results suggest excessive daytime sleepiness (EDS) from the clinical sleep disorders known as the hypersomnias of central origin may have significant consequences on children's daytime functioning in a critical domain of personal safety, pedestrian skills. Cognitive processes involved in safe pedestrian crossings may be impaired in children with EDS. In the pedestrian simulation, children with EDS appeared to show a pattern consistent with inattentional blindness, in that they "looked but did not process" information in their pedestrian environment. Results highlight the need for heightened awareness of potentially irreversible consequences of untreated sleep disorders and identify a possible target for pediatric injury prevention.
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Affiliation(s)
| | | | - David C. Schwebel
- Department of Psychology, University of Alabama Birmingham, Birmingham, AL
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