Characterization of pedestrian accidents and an examination of infrastructure measures to improve pedestrian safety in Israel

Environmental measures to improve pedestrian safety in low- and middle-income countries: a scoping review

OBJECTIVES

This scoping study aims to identify environmental road safety measures implemented in low- and middle-income countries (LMICs) to reduce pedestrian injuries from collisions with motor vehicles.

METHODS

This review followed Arksey and O'Malley's approach and reported results using the PRISMA-SCR 2018 checklist. A literature review was conducted in Medline, Google Scholar, and the Transport Research International Documentation database using keyword-derived medical subject heading terms. A total of 14 articles met the pre-established inclusion criteria and were analyzed using a data extraction matrix. The findings were categorized methodically into three prominent themes: (1) methods for reducing pedestrian exposure, (2) traffic calming strategies, and (3) measures for enhancing pedestrian visibility.

RESULTS

Traffic calming strategies, including vehicular speed reduction, roadway contraction, and vertical and horizontal diversionary tactics, emerged as the most effective interventions for reducing pedestrian injuries within LMICs. Conversely, interventions geared towards minimizing pedestrian exposure, such as zebra crossings, crosswalks controlled by traffic signals, underpasses, or overpasses, often produced minimal effects, and occasionally exacerbated the risk of pedestrian accidents. Lack of pedestrian visibility due to density of street vendors and parked vehicles was associated with a higher risk of injuries, while billboards impaired drivers' attention and increased the likelihood of collisions with pedestrians.

DISCUSSION

In LMICs, the effectiveness of environmental measures in reducing vehicle-pedestrian crashes varies widely. In the face of resource constraints, implementing interventions for pedestrian safety in LMICs necessitates careful prioritization and consideration of the local context.

The immediate effects of vision-zero corridor upgrades on pedestrian crashes in New York: A before-and-after spatial point process approach

The long-term effects of the Vision-Zero (VZ) approach in Scandinavia are well documented. In contrast, information regarding the immediate effects of VZ at the starting phase upon gradual implementation is scarce. Taking New York City as the case study, we analyzed both the local and global effects of the Vision-Zero gradual implementation on pedestrian crashes in the early stage of implementation starting from 2014. The data analysis comprised 8,165 pedestrian injury crashes. Using location data, the crashes were matched to VZ infrastructure improvement location, start and completion dates. The experimental design included a treatment and two types of control conditions, and we controlled for well-known covariates including traffic exposure, land use, and risk-prone areas. We estimated a Geyer Saturation model and kernel density function for modeling the effect of Vision-Zero on crash intensity and dispersion two years before and after the implementation of Vision-Zero. The results reveal a significant global decrease of 6.1 % (p = 0.004) in pedestrian crash incidence in the treated sections compared with the control group two years after the treatment, and a greater dispersion of pedestrian injuries following the policy implementation.

The causation-prevention chain in infrastructure safety measures: A consideration of four types of policy lock-ins

Safety policies typically follow Lasswell's linear decision cycle paradigm: diagnostics, prescription, application, monitoring, and appraisal. Contemporary policy research highlights the existence of complexities in policy-making, which trigger policy lock-ins. We consider four cases in which the complex nature of the causation-prevention discourse leads to decision-making lock-ins, which deter safety progress. The four cases are conflicting narratives, missing causation inferences, prevention and mobility mismatch, and a tension between policy transfer and existing policy environments. The cases are demonstrated on recent examples of infrastructure measures that were observed in Israeli practice, which are, respectively: adding a motorway illumination, setting bus priority routes, safety improvements of multi-lane urban roads, and establishing traffic calming areas. While the four case-studies are region-specific, the discussion is relevant to other road safety measures and countries with similar policy-making problems. The consideration highlights the importance of policy-making dynamics to increase the resilience of the Safe System approach.

Built-environment risk assessment for pedestrians near bus-stops: a case study in Delhi

Pedestrian safety is a serious concern in the developing nations of the world. It is evident from the past studies that built-environment characteristics near bus-stops, play a crucial role on the frequency and overall share of pedestrian deaths and injuries in road traffic crashes. The present study aims to identify critical built-environment features around vulnerable bus-stops in an Indian city and evaluate the odds of risk that prevails on the safety of pedestrians near bus stops. Hotspot analysis was conducted to finalise 177 bus stop sites within high-crash clusters in the study area. Built-environment attributes considered were based on sidewalk, crosswalk and bus stop conditions near such vulnerable locations. This study includes a video graphic and manual field survey conducted during the day and night-time. Logistic regression was applied to estimate the impact of built environment features on pedestrian crashes. Width and disability friendliness of sidewalks, presence of bus bays and on-street parking have significant impacts on pedestrian fatalities at locations with a higher share of pedestrian fatalities during the day. On the other hand, presence of zebra crossings at junctions, proper bus stop lighting and high sidewalks reduce the odds of pedestrian crashes at night near bus stops.

Identification of contributing factors and hotspots of pedestrian-vehicle collisions in urban areas: An alternative hybrid method for small cities

OBJECTIVE

Traffic safety numbers in developing countries show a serious global problem that requires studies and actions to promote safety for the most vulnerable users, such as pedestrians, as a way of contributing to sustainable urban mobility. Therefore, this research proposes a hybrid method to identify contributing factors and critical points according to the profile of crashes involving pedestrians being run over by motor vehicles in small cities.

METHODS

The proposed method uses multivariate data analysis, specifically Exploratory Factor Analysis (EFA) and Cluster Analysis (CA), combined with geospatial tools. The study scenario corresponds to pedestrian-vehicle collisions that occurred in the urban area of Cachoeira do Sul, a small city in Rio Grande do Sul, Brazil, recorded in police reports between 2015 and 2018. Additionally, Geographic Information Tools (GIS) were used to collect characteristics of the road environment.

RESULTS

According to EFA, a set of attributes configured as contributing factors are discussed according to the components of the traffic system: user, road, vehicle, and environment. Subsequently, a CA was applied with the road-environmental factors, and three pedestrian-vehicle collision profiles were extracted, with clustering according to road segments with homogeneous characteristics. Moreover, a Kernel Density Estimate (KDE) was used to obtain heat maps of the pedestrian collisions profiles. The results allowed interventions to be proposed according to the contributing factors of each profile.

CONCLUSIONS

The multivariate statistical analysis supported the discussion of the factors contributing to the occurrence of pedestrian-vehicle collisions in small cities in developing countries. The spatial visualization of the results showed urban corridors with a high risk for pedestrians and the identification of hotspots in the city. In addition, the study demonstrated that the hybrid method tested is an alternative for the government of cities with few resources to promote safety mobility.

Vision-Based Pedestrian's Crossing Risky Behavior Extraction and Analysis for Intelligent Mobility Safety System

Crosswalks present a major threat to pedestrians, but we lack dense behavioral data to investigate the risks they face. One of the breakthroughs is to analyze potential risky behaviors of the road users (e.g., near-miss collision), which can provide clues to take actions such as deployment of additional safety infrastructures. In order to capture these subtle potential risky situations and behaviors, the use of vision sensors makes it easier to study and analyze potential traffic risks. In this study, we introduce a new approach to obtain the potential risky behaviors of vehicles and pedestrians from CCTV cameras deployed on the roads. This study has three novel contributions: (1) recasting CCTV cameras for surveillance to contribute to the study of the crossing environment; (2) creating one sequential process from partitioning video to extracting their behavioral features; and (3) analyzing the extracted behavioral features and clarifying the interactive moving patterns by the crossing environment. These kinds of data are the foundation for understanding road users’ risky behaviors, and further support decision makers for their efficient decisions in improving and making a safer road environment. We validate the feasibility of this model by applying it to video footage collected from crosswalks in various conditions in Osan City, Republic of Korea.

Burden of Road Traffic Injuries in Tanzania: One-Year Prospective Study of Consecutive Patients in 13 Multilevel Health Facilities

BACKGROUND

Road traffic injuries (RTIs) pose a severe public health crisis in Sub-Saharan Africa (SSA) and specifically in Tanzania, where the mortality due to RTIs is nearly double the global rate. There is a paucity of RTI data in Tanzania to inform evidence-based interventions to reduce the incidence and improve care outcomes. A trauma registry was implemented at 13 health facilities of diverse administrative levels in Tanzania. In this study, we characterize the burden of RTIs seen at these health facilities.

METHODS

This was a one-year prospective descriptive study utilizing trauma registry data from 13 multilevel health facilities in Tanzania from 1 October 2019 to 30 September 2020. We provide descriptive statistics on patient demographics; location; share of injury; nature, type, and circumstances of RTI; injury severity; disposition; and outcomes.

RESULTS

Among 18,553 trauma patients seen in 13 health facilities, 7,416 (40%) had RTIs. The overall median age was 28 years (IQR 22-38 years), and 79.3% were male. Most road traffic crashes (RTC) occurred in urban settings (68.7%), involving motorcycles (68.3%). Motorcyclists (32.9%) were the most affected road users; only 37% of motorcyclists wore helmets at the time of the crash. The majority (88.2%) of patients arrived directly from the site, and 49.0% used motorized (two- or three-) wheelers to travel to the health facility. Patients were more likely to be admitted to the ward, taken to operating theatre, died at emergency unit (EU), or referred versus being discharged if they had intracranial injuries (27.8% vs. 3.7%; p < 0.0001), fracture of the lower leg (18.9% vs. 6.4%; p < 0.0001), or femur fracture (12.9% vs. 0.4%; p < 0.0001). Overall, 36.1% of patients were admitted, 10.6% transferred to other facilities, and mortality was 2%.

CONCLUSIONS

RTCs are the main cause of trauma in this setting, affecting mostly working-age males. These RTCs result in severe injuries requiring hospital admission or referral for almost half of the victims. Motorcyclists are the most affected group, in alignment with prior studies. These findings demonstrate the burden of RTCs as a public health concern in Tanzania and the need for targeted interventions with a focus on motorcyclists.

Citizens’ Perceptions in Relation to Transport Systems and Infrastructures: A Nationwide Study in the Dominican Republic

One of the challenges currently faced by emerging countries is to get their citizens to decide to use sustainable transport for their regular trips, in order to reduce the current vehicular pollution rates. The objective of this descriptive research is to examine the perceptions of Dominicans regarding the state of the country’s transport systems and road infrastructure. For this purpose, a nationwide survey procedure was performed. This cross-sectional research used the data retrieved from a sample of 1260 citizens aged over 18, proportional in gender, age, habitat, and province of the Dominican Republic. The results showed how Dominicans believe that, compared to other road features, pedestrian roads and public transport vehicles remain in a very poor condition. Further, citizens report to be more interested about the improvement of road infrastructures than in the implementation of any other set of measures performed to promote sustainable road mobility, including those related with alternative transport means. Finally, this study claims for the need of fostering educational, communicative and participative actions and measures aimed at increasing the value given to sustainable transportation, and the relevance of integrate potential structural and vehicular improvements with those related to human behavior in mobility.

Proactive pedestrian safety evaluation at urban road network level, an experience in Kolkata City, India

In developing nations, road traffic crashes involving pedestrians have become a foremost worry. Presently, most of the road safety assessment projects and selection of interventions are still restricted to traditional methods that depend on historical crash data. However, in low and middle-income countries such as India, the availability, reliability, and accuracy of crash data are uncertain. Alternatively, Post Encroachment Time (PET) has added attention as a proximal indicator to examine pedestrian-vehicular potential crashes and address pedestrian risk under mixed traffic conditions. Hence, it will be meaningful to examine if the PET is a good substitute for pedestrian-vehicular crashes and if so, what built environment and pedestrian-level factors influence PET. In this background, the present study establishes a mathematical association between the average PET value of the urban road network level and actual crashes. Afterward, multiple linear regression models are developed to study the impact of the built environment, traffic parameters, and pedestrian-level attributes on PET. The outcomes indicate that vehicle speed, lack of enforcement, absence of traffic signal (for traffic as well as pedestrians), land use type, slum population, inadequate sight distance, pedestrian's state of crossing, and pedestrian's risky crossing behaviour substantially affect the average PET at road network-level.

"My right to walk, my right to live": pedestrian fatalities, roads and environmental features in Benin

Background

The implementation of road safety interventions in many developing countries usually focuses on the behavior of users. In order to draw more attention on the role of road infrastructure and physical environment in road safety interventions, this study aims to analyze the environmental and road factors associated with the pedestrians involved in traffic crashes in Benin.

Method

The method used was an analysis of national road crash statistics for the period 2008 to 2015. The information available included the circumstances surrounding the collision, the road infrastructure, the vehicles and the individuals involved. A multiple logistic regression was used to identify predictors of pedestrian mortality in traffic crashes.

Results

During the period studied, 3760 crashes involved at least one pedestrian. The death rate among these pedestrians was 27.74% (CI 95%: 26.31–29.20). The mortality predictors were the area in which the crash occurred (OR = 4.94; CI 95%: 4.10–5.94), the day of the crash (OR = 2.17; CI 95%:1.34–3.52), light levels (OR = 1.30; CI 95%: 1.06–1.59), road classification (OR = 1.79; CI 95%: 1.46–2.20), the condition of the road surface (2.04, CI 95%: 1.41–2.95) and the position of the pedestrian during the crash (OR = 1.69; CI 95%: 1.19–2.38).

Conclusions

These results support the need for a holistic approach to interventions aiming to tackle deaths on roads. Interventions should integrate environmental factors for greater pedestrian safety around roads with appropriate signs, roads in good condition and awareness campaigns for a proper use of road infrastructures.

Urban road space allocation incorporating the safety and construction cost impacts of lane and footpath widths

INTRODUCTION

Walkability continues to attract great attention from urban planners, designers, and engineers as they recognize not only the merits of pedestrian facilities in terms of the health benefits but also their demerits in terms of accident risk to pedestrians. Wide footpaths improve the pedestrian environment and experience, and thereby motivate travelers to walk as much as possible. However, if footpaths are too wide, they may leave a smaller space for the roadway. On the other hand, wide road lanes may lead to higher road vehicle safety but are costly to construct and maintain and also may leave little space for the footpath. Evidently, for a fixed urban space, what is needed is an optimal balance between the vehicle lane and pedestrian path. This problem is encountered routinely in dense cities including Hong Kong where land availability is severely limited.

METHOD

To address the issue, this paper first establishes safety performance functions (SPFs) for the pedestrian space and the road space, using the random-parameter negative binomial regression. The results indicate the extent to which road lane and footpath width changes are associated with changes in in-vehicle occupant and pedestrian casualties. Then the paper uses the SPFs to develop a methodology for optimizing the width allocations to the road lanes and footpaths, duly considering the user (safety) costs and agency (construction) costs associated with each candidate allocation of the widths. Finally, the paper analyzes the sensitivity of the optimal solution to the relative weights of user cost and agency cost.

RESULTS

When user and agency costs are considered equally important, the optimal lane width is 5.4 m.

CONCLUSION

It is observed that the road space allocation ratio used by the Hong Kong road agency suggests that the agency places a higher weight to user cost compared to agency cost. Practical Application: The findings can help incorporate design-safety relationships, and the stakeholders (agency and users) perspectives in urban road and footpath design.

Characteristics of pedestrian injuries caused due to impacts with powered 2-wheelers in India

Objective: This study aims to understand the nature, severity, and sources of injuries sustained by pedestrians involved in crashes with powered 2-wheelers (PTWs) in India. Further, it aims to understand the pedestrian injury pattern and injury mechanism based on the pedestrian contact location on the PTW. Methods: Eight years of field data from the Road Accident Sampling System-India (RASSI) database were considered for the study. Analyses were performed using both weighted and unweighted RASSI data. A sample of 57 crashes between pedestrians and PTWs was analyzed to determine the pedestrian injury characteristics, pedestrian orientation with PTW, and PTW contact zone (PCZ) or the pedestrian contact location on PTW. The PCZs were classified into 3 types. The risk of sustaining a Maximum Abbreviated Injury Scale (MAIS) injury to the head and pedestrian injury mechanism across the 3 PCZs was analyzed. Results: The results of both weighted and unweighted RASSI data were consistent. About 67% of pedestrians who were killed sustained MAIS 3+ head injuries and 52% of pedestrians with nonfatal injuries sustained MAIS 2+ lower extremity injuries. The risk of MAIS 3+/fatal head injury is notably higher (86%) for pedestrians struck from behind compared to pedestrians struck from the side (36%). Of the 3 PCZs, about 80% of the pedestrians contacting PCZ-1 (corner of the PTW front end) sustained fatal head injuries and only 5% contacting PCZ-2 (center of the PTW front end) sustained fatal head injuries. About 40% contacting PCZ-3 (combination of PCZ-1 and PCZ-2) sustained fatal head injuries. Of all AIS 3+ head injuries, 88% were associated with ground impacts. Of all AIS 2+ lower extremity injuries, 96% were associated with impacts to PTW front-end parts. Conclusions: The results show that head injuries account for most pedestrian fatalities in crashes with PTWs and lower extremity injuries account for most nonfatal injuries. Head injuries are associated with ground contacts and lower extremity injuries are associated with contacting PTW front-end parts. Pedestrians contacting the corner of the PTW are highly prone to MAIS 3+ head injuries, whereas pedestrians contacting the center of the PTW are less prone to MAIS 3+ head injuries. This difference is predominantly because of the varied injury mechanisms seen across PCZs.

Small and Light Electric Vehicles: An Analysis of Feasible Transport Impacts and Opportunities for Improved Urban Land Use

Improvements in battery technology have resulted in small and light electric vehicles (LEVs) appearing on the market in Europe since 2011—however, their market share is still comparatively low. Low energy requirements and small size can potentially contribute to sustainable mobility in terms of climate protection and reduced local emissions. Our study evaluates how three-wheeled and four-wheeled vehicles, categorised as L-Class according to Regulation (EU) No 168/2013, can contribute to more efficient use of space in urban areas. Evaluations of expert interviews, an extensive literature research, and analyses of the German national household travel survey (MiD) serve as the basis of the study. First, the substitution potential of trips through LEVs is explored using MiD data. Our findings show that between 17% and 49% of trips made and 6% to 30% of the distance covered by private trips can theoretically be substituted by LEVs. Thus, reorganisation of current land use offers potential and additionally, LEVs are an attractive and sustainable addition to other means of transport and contribute to achieving the climate protection goals of the transport sector. Due to the fact that technology application is restricted by travel behaviour and political support, our study discusses possible support by public bodies towards sustainable mobility. Here, the promotion of LEVs in combination with restrictive measures for cars is necessary.

Speeds of Young E-Cyclists on Urban Streets and Related Risk Factors: An Observational Study in Israel

In Israel, a growing use of electric bicycles by youngsters has been noted, with an increase in related injuries. In this study, an observational survey was conducted on typical urban streets, aiming to characterize the riding speeds of young e-cyclists compared to regular cyclists and the associated risk factors in their behaviors. The survey covered 39 sites in eight cities, and included 1054 cyclists. The results showed that mean speeds of young e-cyclists were higher than those of regular cyclists at all types of sites, with a difference of 6–9 km/h. The mean speeds of e-bicycles were below 25 km/h, as prescribed by law, but the 85-percentile speeds were higher. E-cyclist speeds depend on the type of street, road layout and place of riding. More e-cyclists used the roadway compared to regular cyclists, however, on divided roads, more e-cyclists used sidewalks in spite of the law prohibition, thus endangering pedestrians. The majority of cyclists did not wear helmets. The unsafe behaviors of teenage e-cyclists increase the injury risk for themselves and for other road-users. Thus, separate bicycle infrastructure should be promoted in the cities. Road safety education and training of young e-cyclists with stronger enforcement of traffic regulations are also needed.

A Multilevel Model Approach for Investigating Individual Accident Characteristics and Neighborhood Environment Characteristics Affecting Pedestrian-Vehicle Crashes

Walking is the most basic movement of humans and the most fundamental mode of transportation. To promote walking, it is necessary to create a safe environment for pedestrians. However, pedestrian-vehicle crashes still remain relatively high in South Korea. This study employs a multilevel model to examine the differences between the lower-level individual characteristics of pedestrian crashes and the upper-level neighborhood environmental characteristics in Seoul, South Korea. The main results of this study are as follows. The individual characteristics of pedestrian-vehicle crashes are better at explaining pedestrian injury severity than built environment characteristics at the neighborhood level. Older pedestrians and drivers suffer more severe pedestrian injuries. Larger vehicles such as trucks and vans are more likely to result in a high severity of pedestrian injuries. Pedestrian injuries increase during inclement weather and at night. The severity of pedestrian injuries is lower at intersections and crosswalks without traffic signals than at crosswalks and intersections with traffic signals. Finally, school zones and silver zones, which are representative policies for pedestrian safety in South Korea, fail to play a significant role in reducing the severity of pedestrian injuries. The results of this study can guide policymakers and planners when making decisions on how to build neighborhoods that are safer for pedestrians.

Vision-Based Potential Pedestrian Risk Analysis on Unsignalized Crosswalk Using Data Mining Techniques

Though the technological advancement of smart city infrastructure has significantly improved urban pedestrians’ health and safety, there remains a large number of road traffic accident victims, making it a pressing current transportation concern. In particular, unsignalized crosswalks present a major threat to pedestrians, but we lack dense behavioral data to understand the risks they face. In this study, we propose a new model for potential pedestrian risky event (PPRE) analysis, using video footage gathered by road security cameras already installed at such crossings. Our system automatically detects vehicles and pedestrians, calculates trajectories, and extracts frame-level behavioral features. We use k-means clustering and decision tree algorithms to classify these events into six clusters, then visualize and interpret these clusters to show how they may or may not contribute to pedestrian risk at these crosswalks. We confirmed the feasibility of the model by applying it to video footage from unsignalized crosswalks in Osan city, South Korea.

Pedestrian risky behavior and safety at zebra crossings in a Ghanaian metropolitan area

OBJECTIVE

This article assesses pedestrian behavior and safety at zebra crossings in the Cape Coast Metropolis.

METHOD

A mix of a naturalistic exploratory and descriptive study was conducted using both primary and secondary data. The primary data included an observational study of over 6,000 pedestrians using zebra crossings in the metropolis. The secondary data were obtained from the national road traffic crashes (RTCs) database at the Building and Road Research Institute covering information on pedestrian crashes between 2007 and 2016 in the metropolis. Analyses were conducted using frequencies and percentages with Pearson's chi-square correlation used to establish the relationship between independent and dependent variables.

RESULTS

The findings showed that the majority of the 328 pedestrian crashes between 2007 and 2016 resulted in either fatalities or serious injuries and occurred at locations away from a junction. Most of the pedestrians observed used the zebra crossing were alone and engaged in talking or using mobile phone. Age group, pedestrian status, and the location of the zebra crossings influenced pedestrians' risky behaviors.

CONCLUSION

The majority of the pedestrian crashes in the metropolis resulted in injuries resulting in hospitalization or fatalities and occurred at a midblock. Pedestrians largely exhibited risky behaviors predisposing the occurrence of RTCs at zebra crossings despite the fact that they are a pedestrian right-of-way. There is therefore the need for the National Road Safety Commission to carry out campaigns to educate pedestrians on the safer use of zebra crossings.

Influence of drivers' psychological risk profiles on the effectiveness of traffic calming measures

Road traffic injuries represent a serious public health problem and are one of leading cause of death, injury and disability around the world. Road accidents are often caused by an accumulation of factors; however, drivers appear to be by far the most decisive one. The driver's behaviour is complex and depends on reflex (or involuntary) and voluntary driving actions. The first class of actions (reflex actions) are typical human reactions that remain inaccessible to awareness and refer to the direct interaction between the road user and the characteristics of the road and its surrounding environment. Conversely, voluntary actions are conscious behaviours adopted on the basis of planned decisions. Both types of driving actions act simultaneously and the interaction between them and their relative effects on road safety are an aspect not yet well examined. The main objective of this study was to provide, by means of a driving simulation experiment, an insight on this interaction by evaluating the influence of some psychological characteristics on the effectiveness of different types of traffic calming measures at pedestrian crossings, designed according to the Human Factors principles. Fifty-eight participants drove a virtual urban route while data on their performance, as they approached five configurations of pedestrian crossings equipped with different physical and perceptual treatments, were collected. The participants were preliminarily characterized by means of two psychological questionnaires, which allowed the identification of three distinct groups of drivers belonging to three risk profiles (careful, worried, and at risk). The three groups of drivers reacted differently to the proposed engineering treatments, confirming the clustering identified by the preliminary analysis. The results showed that the proposed traffic calming measures are effective on all psychological sub-groups of drivers, with different effectiveness. These first results support that, in the considered driving environment (pedestrian crossings), the Human Factors approach, with which traffic calming measures can be arranged, could be effective, even if different psychological sub-groups are differently affected.

Exploring patterns of child pedestrian behaviors at urban intersections

Children are more vulnerable as pedestrians due to their cognitive, physical and behavioral traits. However, walking is one of the main forms of travel for children, particularly during leisure hours. Child pedestrian injury primarily occurs in urban areas, with a significant share at crosswalks. This study observed child pedestrian behaviors at crosswalks of urban intersections aiming to characterize their behavior patterns and identify risk factors that may lead to injury. Crossing behaviors of children and adolescents up to age 18, during leisure hours, were video-recorded at 29 crosswalks, on signalized and un-signalized intersections situated on collector roads. Some children used pedestrian crosswalks while riding a bicycle or other non-motorized means; they were also included in the sample. Behaviors of 2930 young road users were encoded and compared by age groups. Multivariate logistic regression models were adjusted to identify factors associated with crossing on red and with non-checking vehicle traffic at un-signalized crosswalks. The findings pointed to different behavior patterns for the various child age groups. Risk-taking behaviors are higher for older children; adolescents aged 14-17 cross more on red, without checking traffic, outside crosswalk boundaries and while distracted. At all types of sites, a fifth of children over the age of 9 crossed by riding, the probability of crossing on red and of non-checking traffic prior to crossing at an un-signalized crosswalk was higher for children riding an electric bicycle or kick-scooter. The non-checking of traffic was also higher when a child is distracted by a mobile phone or other electronic gadget, or carries a big object. Children under age 9 were usually accompanied by adults but still exhibited risk-taking behaviors that apparently mirrored those of the adults. Risk-taking behaviors of young road users should be taken into account in the development of injury prevention programs focusing on child and parent education and training, and by adapting the urban environment to better meet their needs.

Novel Methods for Environmental Assessment of Pedestrian Injury: Creation and Validation of the Inventory for Pedestrian Safety Infrastructure

Nationally, 80% of pedestrian fatalities occur in urban environments, yet the distribution of injuries across urban areas is not uniform. Identifying street-level risk factors for pedestrian injury is essential for urban planning and improvement projects, as well as targeted injury prevention efforts. However, creating and maintaining a comprehensive database of a city's traffic safety infrastructure can be cumbersome and costly. The purpose of this study was to create and validate a neighborhood environmental observational assessment tool to capture evidence-based pedestrian safety infrastructure using Google Street View (GSV)-The Inventory for Pedestrian Safety Infrastructure (IPSI). We collected measures in-person at 172 liquor stores in Baltimore City from June to August 2015 to assess the tool's reliability; we then collected IPSI measures at the same 172 locations using GSV from February to March 2016 to assess IPSI reliability using GSV. The majority of items had good or excellent levels of inter-rater reliability (ICC ≥ 0.8), with intersection features showing the highest agreement across raters. Two scales were also developed using exploratory factor analysis, and both showed strong internal consistency (Cronbach's alpha ≥ 0.6). The IPSI provides a valid, economically efficient tool for assessing pedestrian safety infrastructure that can be employed for a variety of research and urban planning needs. It can also be used for in-person or GSV observation. Reliable and valid measurement of pedestrian safety infrastructure is essential to effectively prevent future pedestrian injuries.

Epidemiology and Outcome Determinants of Pedestrian Injuries in a Level I Trauma Center in Southern Iran; A Cross-Sectional Study

Objective

To epidemiologically assess the accidents and incidents in the injured pedestrians referred to Shahid Rajaee Hospital, Shiraz in order to provide basic preventive strategies and reduce injuries and fatalities caused by traffic accidents in pedestrians.

Methods

This cross-sectional study was conducted on 5840 injured pedestrians referred to Shahid Rajaee Hospital, Shiraz from 2009 to 2014. The baseline characteristic including the demographic and clinical information, the mechanism of injury, injury severity score (ISS) and outcome determinants. We also recorded the outcome measures and the mortality. Multivariate logistic regression analysis was performed to investigate the factors related to mortality rate and Length of Stay (LOS) in hospital.

Results

In our study, the history of 5840 injured pedestrians was analyzed. The mean age of the patients was 41.32 ± 19.21 years. Multivariate logistic regression indicated that mortality increased with age. Moreover, the odds of mortality was more in patients with Injury Severity Score (ISS) between 16 and 24 [OR: 12.94, 95% CI (3.78-32.66), p=0.001] and injuries in the head and neck [OR: 7.92, 95% CI (4.18-14.99), p=0.020]. LOS in hospital was also higher in patients with ISS > 25 [OR: 16.65, 95%CI (10.68-25.96), p=0.001].

Conclusion

Pedestrians have always been one of the most vulnerable road users. Our study indicated that the adverse consequences and mortalities in pedestrians increased with age. Hence, approaches are required to improve primary prevention programs and reduce deaths and injuries due to this major public health problem.

"Outta my way!" Individual and environmental correlates of interactions between pedestrians and vehicles during street crossings

Because pedestrian crash rates remain lower than other collision types, surrogate measures such as traffic interactions are now used in road safety research to complement crash history. Using naturalistic data collection, we sought to assess 1) the likelihood of occurrence of interactions between pedestrians and vehicles based on individual and crossing characteristics; and 2) differences in interaction characteristics between children, adult and senior pedestrians. Observations of pedestrian crossing behaviours (n=4687) were recorded at 278 crossings. For recorded interactions (n=843), information was collected to characterize the behaviours of involved parties. A mixed-effect logit regression model was performed to assess the factors associated with interactions. Chi-square tests evaluated differences between age groups and characteristics of observed interactions. Older adults were those more likely to be involved in an interaction event. Bicycle paths, different crossing surface material and one-way streets were significantly associated with fewer interactions with vehicles, while parked vehicles nearby and crossings on arterial roads were significantly associated with more interactions. Children and the elderly (80 years of age or more) did have distinct patterns of interaction, with more careful drivers/cyclists behaviours being observed towards children and lesser regulation compliance towards the elderly. Given the growing emphasis and adoption of active transportation in many cities, the number of interactions between pedestrians and vehicles during street crossings is likely to increase. Educating drivers and pedestrians to respect each other's space requires an understanding of where, between whom, and under what circumstances interactions occur. Such an approach can also help identify which engineering and enforcement programs are needed to ensure safe pedestrian crossings since interactions can be good markers of uncomfortable crossing situations that may deter walking and lead to more collisions.

How young pedestrians do explain their risky road crossing behaviors? A qualitative study in Iran

Background: Although pedestrian-vehicle accidents are often the results of risky behaviors during road crossings, there is limited evidence concerning the risky road crossing behaviors of pedestrians. This study was aimed at eliciting and exploring the reasons that can help explain why young pedestrians take risky road crossing behaviors.

Methods: A qualitative content analysis approach was conducted on purposefully selected young individuals who had the experience of vehicle-collision accident. Data collected by in depth, semi-structured interviews until data saturation and concurrently analyzed, assisted by MAXQDA 10.

Results: Three main categories emerged as social reasons for risky road crossing behaviors of the young pedestrians including ‘conformity with the masses/crowds’, ‘lack of social cohesion and sense of belonging in social relations’ and ‘bypassing the law/ law evasion’.

Conclusion: The risky road crossing behaviors of young pedestrians are found influenced by the pedestrian attitudes towards the political, social, cultural and economic condition of the society.Moreover, popular culture and collective behaviors in crossing the roads influenced the risky behaviors. Hence, personal, cultural and social interventions could be effective in promoting the young pedestrians’ behavior.

Hierarchical ordered model for injury severity of pedestrian crashes in South Korea

INTRODUCTION

The high percentage of fatalities in pedestrian-involved crashes is a critical social problem. The purpose of this study is to investigate factors influencing injury severity in pedestrian crashes by examining the demographic and socioeconomic characteristics of the regions where crashes occurred.

METHOD

To understand the correlation between the unobserved characteristics of pedestrian crashes in a defined region, we apply a hierarchical ordered model, in which we set crash characteristics as lower-level variables and municipality characteristics as upper-level. Pedestrian crash data were collected and analyzed for a three-year period from 2011 to 2013. The estimation results show the statistically significant factors that increase injury severity of pedestrian crashes.

RESULTS

At the crash level, the factors associated with increased severity of pedestrian injury include intoxicated drivers, road-crossing pedestrians, elderly pedestrians, heavy vehicles, wide roads, darkness, and fog. At the municipality level, municipalities with low population density, lower level of financial independence, fewer doctors, and a higher percentage of elderly residents experience more severe pedestrian crashes. Municipalities ranked as having the top 10% pedestrian fatality rate (fatalities per 100,000 residents) have rates 7.4 times higher than municipalities with the lowest 10% rate of fatalities. Their demographic and socioeconomic characteristics also have significant differences. The proposed model accounts for a 7% unexplained variation in injury severity outcomes between the municipalities where crashes occurred.

CONCLUSION

To enhance the safety of vulnerable pedestrians, considerable investments of time and effort in pedestrian safety facilities and zones should be made. More certain and severe punishments should be also given for the traffic violations that increase injury severity of pedestrian crashes. Furthermore, central and local governments should play a cooperative role to reduce pedestrian fatalities. Practical applications: Based on our study results, we suggest policy directions to enhance pedestrian safety.

Pedestrian road crossing behavior (PEROB): Development and psychometric evaluation

OBJECTIVE

The aim of this study was to develop a theory-based questionnaire to measure road crossing attitudes and potentially risky pedestrian behavior.

METHODS

A cross-sectional validation study was carried out on a total sample of 380 young adults aged 18 to 25 years who live in Tehran, Iran. Data were collected from January 27 to May 20, 2015, using a self-administered structured pool of 76 items that was developed from research on the theory of planned behavior. A panel of subject-matter experts evaluated the items for content validity index and content validity ratio, and the questionnaire was pretested. Exploratory factor analysis (EFA) was performed to test construct validity. The Cronbach's alpha coefficient and intraclass correlation coefficient (ICC) analyses were done to assess internal consistency and stability of the scale.

RESULTS

From the initial 76 items, 38 items were found to be appropriate for assessing the pedestrian road crossing behavior (PEROB) of young adults in Tehran. A 9-factor solution revealed an exploratory factor analysis that jointly accounted for 63.8% of the variance observed. Additional analyses also indicated acceptable results for the internal consistency with Cronbach's alpha value ranging from 0.67 to 0.88 and ICC values ranging from 0.64 to 0.96.

CONCLUSIONS

This psychometric evaluation of a self-administered instrument resulted in a reliable and valid instrument to assess young adult pedestrians' self-reported road crossing attitudes and behaviors in Tehran. Further development of the instrument is needed to assess its applicability to other road users, particularly older pedestrians.

Illegal road crossing behavior of pedestrians at overpass locations: Factors affecting gap acceptance, crossing times and overpass use

The aim of designing overpasses is to provide safe road crossings for pedestrians by helping them to avoid conflicts with motor vehicles. However, the number of pedestrians who do not use overpasses to cross the road is very high. An observational survey of illegal road crossings was conducted at four overpass locations in Izmir, Turkey to determine the crossing time, crossing speed of the pedestrians and their distance and time gap perception for safe road-crossing within 25 m of the overpasses in both directions. Crossing time is the time needed for a pedestrian to cross a particular road. Time gap is strongly related with safety margin. If a pedestrian chooses a larger time gap, then the arrival time of the oncoming vehicle to the crossing point of the pedestrian increases thus, the possibility of a collision decreases. Each overpass was observed on weekdays during peak afternoon (12.30-13.30) and evening hours (17.00-18.00). At all overpass locations 454 illegal crossings were observed. ANOVA results revealed that age had a significant effect both on safety margin and crossing time. During the observations a survey was conducted among pedestrians who completed their crossings either using the overpass or at street level within 25 m of the overpass (n=231). Factors affecting the crossing choice of pedestrians were specified in the surveys. The major part of the respondents (71.7%) indicated that time saving was the main reason for crossing at street level. Pedestrians' crossing speeds were extracted from the video recordings to observe the effect of speed limit on pedestrian behavior. As a result, at locations where the speed limit was 70 km/h, pedestrians' average crossing speed was found to be 1.60 m/s and 1.73 m/s while at locations where the speed limit was 50 km/h, pedestrians' average crossing speed was found to be 1.04 m/s and 0.97 m/s. This shows that pedestrians feel safer while crossing when the vehicle speed is low.

The influence of traffic signal solutions on self-reported road-crossing behavior

Injury to pedestrians is a major safety hazard in many countries. Since the beginning of the last century, modern cities have been designed around the use of motor vehicles despite the unfavourable interactions between the vehicles and pedestrians. This push towards urbanization resulted in a substantial number of crashes and fatalities involving pedestrians every day, all over the world. Thus, improving the design of urban cities and townships is a pressing issue for modern society. The study presented here provides a characterization of pedestrian safety problems, with the emphasis on signalized crosswalks (i.e. traffic signal) design solutions. We tested the impact of seven different traffic light configurations (steady [green, yellow, and red], flashing [green, yellow, and red], and light off) on pedestrian self-reported road-crossing behavior, using a 11-point scale -ranging from 0 ("I never cross in this situation") to 10 ("I always cross in this situation"). Results showed that mandatory solutions (steady green vs. steady red) are the best solutions to avoid unsafe pedestrian behaviors while crossing controlled intersections (frequency of crossing: Mgreen = 9.4 ± 1 vs. Mred = 2.6 ± 2). These findings offer important guidelines for the design of future traffic signals for encouraging a pedestrian/transit-friendly environment.

Explaining Chile's traffic fatality and injury reduction for 2000-2012

OBJECTIVES

The objective of the current study is to determine the contribution of Chile's 2005 traffic law reform, police enforcement, and road investment infrastructure to the reduction of traffic fatalities and severe injuries from 2000 to 2012.

METHODS

Analyses based on structural equation models were carried out using a unique database merging aggregate administrative data from several Chilean public institutions. The sample was balanced (13 regions, over 13 years; N=169). Dependent variables were rates of traffic fatality (total, drivers, passengers, and pedestrians), severe injuries, and total number of crashes per vehicle fleet. Independent variables were (1) traffic law reform, (2) police enforcement, and (3) road infrastructure investment. Oil prices, alcohol consumption, proportion of male population 15-24 years old, unemployment, years' effects and regions' effects, and lagged dependent variables were entered as control variables.

RESULTS

Empirical estimates from the structural equation models suggest that the enactment of the traffic law reform is significantly associated with a 7% reduction of pedestrian fatalities. This association is entirely mediated by the positive association the law had with increasing police enforcement and reducing alcohol consumption. In turn, police enforcement is significantly associated with a direct decrease in total fatalities, driver fatalities, passenger fatalities, and pedestrian fatalities by 17%, 18%, 8%, and 60%, respectively. Finally, road infrastructure investment is significantly associated with a direct reduction of 11% in pedestrian fatalities, and the number of total crashes significantly mediates the effect of road infrastructure investment on the reduction of severe injuries. Tests of sensitivity indicate these effects and their statistical significance did not vary substantively with alternative model specifications.

CONCLUSIONS

Results suggest that traffic law reform, police enforcement, and road infrastructure investment have complex interwoven effects that can reduce both traffic fatalities and severe injuries. Though traffic reforms are ultimately designed to change road user behaviors at large, it is also important to acknowledge that legislative changes may require institutional changes--that is, intensification of police enforcement--and be supported by road infrastructure investment, in order to effectively decrease traffic fatalities and injuries. Furthermore, depending on how road safety measures are designed, coordinated, and implemented, their effects on different types of road users vary. The case of Chile illustrates how the diffusion of road safety practices globally promoted by the World Health Organization and World Bank, particularly in 2004, can be an important influence to enhance national road safety practices.

Ethnicity and road traffic injuries: differences between Jewish and Arab children in Israel

OBJECTIVE

To examine the differences and characteristics of road traffic injuries (RTIs) among Jewish and Arab children, ages 0-17 years, in Israel.

DESIGN

A retrospective study based on data from the Israeli National Trauma Registry between 2001 and 2010. This study relates specifically to traffic-related hospitalizations among children ages 0-17 years. Data include demographic, injury, and hospitalization characteristics. Descriptive statistics and adjusted logistic regression were used to examine the differences of RTIs between the two ethnic groups.

RESULTS

A total of 18,884 children were included, of which Arab children comprised 38.2% of the total and 44.1% of the severely injured. Among Arab children 41.8% were pedestrians compared to 33.4% among Jewish children (p<0.0001). Arab children were younger, had more severe injuries and more traumatic brain injury (TBI) compared to Jewish children. Adjusted logistic regression analysis shows that the probability of an Arab child, relative to a Jewish child, to undergo surgical procedures was 1.2 (p<0.0001), to be hospitalized in intensive care units (ICUs) was 0.8 (p=0.003), and to be transferred to rehabilitation was 0.5 (p<0.0001). There was no significant difference in inpatient mortality between the two ethnic groups.

CONCLUSIONS

Arab children in Israel are more likely to be hospitalized due to road accidents in comparison to Jewish children. Intervention programs should focus on Arab children and their unique characteristics.