An ecological study of the locations of schools and child pedestrian injury collisions

Developing equity-aware safety performance functions for identifying hotspots of pedestrian-involved crashes

Crashes are frequently disproportionally observed in disadvantaged areas. Despite the evident disparities in transportation safety, there has been limited exploration of quantitative approaches to incorporating equity considerations into road safety management. This study proposes a novel concept of equity-aware safety performance functions (SPFs), enabling a distinct treatment of equity-related variables such as race and income. Equity-aware SPFs introduce a fairness distance and integrate it into the log-likelihood function of the negative binomial regression as a form of partial lasso regularization. A parameter λ is used to control the importance of the regularization term. Equity-aware SPFs are developed for pedestrian-involved crashes at the census tract level in Virginia, USA, and then employed to compute the potential for safety improvement (PSI), a prevalent metric used in hotspot identification. Results show that equity-aware SPFs can diminish the effects of equity-related variables, including poverty ratio, black ratio, Asian ratio, and the ratio of households without vehicles, on the expected crash frequencies, generating higher PSIs for disadvantaged areas. Based on the results of Wilcoxon signed-rank tests, it is evident that there are significant differences in the rankings of PSIs when equity awareness is considered, especially for disadvantaged areas. This study adds to the literature a new quantitative approach to harmonize equity and effectiveness considerations, empowering more equitable decision-making in safety management, such as allocating resources for safety enhancement.

Effectiveness of road safety interventions: An evidence and gap map

Background

Road Traffic injuries (RTI) are among the top ten leading causes of death in the world resulting in 1.35 million deaths every year, about 93% of which occur in low- and middle-income countries (LMICs). Despite several global resolutions to reduce traffic injuries, they have continued to grow in many countries. Many high-income countries have successfully reduced RTI by using a public health approach and implementing evidence-based interventions. As many LMICs develop their highway infrastructure, adopting a similar scientific approach towards road safety is crucial. The evidence also needs to be evaluated to assess external validity because measures that have worked in high-income countries may not translate equally well to other contexts. An evidence gap map for RTI is the first step towards understanding what evidence is available, from where, and the key gaps in knowledge.

Objectives

The objective of this evidence gap map (EGM) is to identify existing evidence from all effectiveness studies and systematic reviews related to road safety interventions. In addition, the EGM identifies gaps in evidence where new primary studies and systematic reviews could add value. This will help direct future research and discussions based on systematic evidence towards the approaches and interventions which are most effective in the road safety sector. This could enable the generation of evidence for informing policy at global, regional or national levels.

Search Methods

The EGM includes systematic reviews and impact evaluations assessing the effect of interventions for RTI reported in academic databases, organization websites, and grey literature sources. The studies were searched up to December 2019.

Selection Criteria

The interventions were divided into five broad categories: (a) human factors (e.g., enforcement or road user education), (b) road design, infrastructure and traffic control, (c) legal and institutional framework, (d) post-crash pre-hospital care, and (e) vehicle factors (except car design for occupant protection) and protective devices. Included studies reported two primary outcomes: fatal crashes and non-fatal injury crashes; and four intermediate outcomes: change in use of seat belts, change in use of helmets, change in speed, and change in alcohol/drug use. Studies were excluded if they did not report injury or fatality as one of the outcomes.

Data Collection and Analysis

The EGM is presented in the form of a matrix with two primary dimensions: interventions (rows) and outcomes (columns). Additional dimensions are country income groups, region, quality level for systematic reviews, type of study design used (e.g., case-control), type of road user studied (e.g., pedestrian, cyclists), age groups, and road type. The EGM is available online where the matrix of interventions and outcomes can be filtered by one or more dimensions. The webpage includes a bibliography of the selected studies and titles and abstracts available for preview. Quality appraisal for systematic reviews was conducted using a critical appraisal tool for systematic reviews, AMSTAR 2.

Main Results

The EGM identified 1859 studies of which 322 were systematic reviews, 7 were protocol studies and 1530 were impact evaluations. Some studies included more than one intervention, outcome, study method, or study region. The studies were distributed among intervention categories as: human factors (n = 771), road design, infrastructure and traffic control (n = 661), legal and institutional framework (n = 424), post-crash pre-hospital care (n = 118) and vehicle factors and protective devices (n = 111). Fatal crashes as outcomes were reported in 1414 records and non-fatal injury crashes in 1252 records. Among the four intermediate outcomes, speed was most commonly reported (n = 298) followed by alcohol (n = 206), use of seatbelts (n = 167), and use of helmets (n = 66). Ninety-six percent of the studies were reported from high-income countries (HIC), 4.5% from upper-middle-income countries, and only 1.4% from lower-middle and low-income countries. There were 25 systematic reviews of high quality, 4 of moderate quality, and 293 of low quality.

Authors' Conclusions

The EGM shows that the distribution of available road safety evidence is skewed across the world. A vast majority of the literature is from HICs. In contrast, only a small fraction of the literature reports on the many LMICs that are fast expanding their road infrastructure, experiencing rapid changes in traffic patterns, and witnessing growth in road injuries. This bias in literature explains why many interventions that are of high importance in the context of LMICs remain poorly studied. Besides, many interventions that have been tested only in HICs may not work equally effectively in LMICs. Another important finding was that a large majority of systematic reviews are of low quality. The scarcity of evidence on many important interventions and lack of good quality evidence-synthesis have significant implications for future road safety research and practice in LMICs. The EGM presented here will help identify priority areas for researchers, while directing practitioners and policy makers towards proven interventions.

Development of a community severance index for urban areas in the United States: A case study in New York City

BACKGROUND AND AIMS

Traffic-related exposures, such as air pollution and noise, have a detrimental impact on human health, especially in urban areas. However, there remains a critical research and knowledge gap in understanding the impact of community severance, a measure of the physical separation imposed by road infrastructure and motorized road traffic, limiting access to goods, services, or social connections, breaking down the social fabric and potentially also adversely impacting health. We aimed to robustly quantify a community severance metric in urban settings exemplified by its characterization in New York City (NYC).

METHODS

We used geospatial location data and dimensionality reduction techniques to capture NYC community severance variation. We employed principal component pursuit, a pattern recognition algorithm, combined with factor analysis as a novel method to estimate the Community Severance Index. We used public data for the year 2019 at census block group (CBG) level on road infrastructure, road traffic activity, and pedestrian infrastructure. As a demonstrative application of the Community Severance Index, we investigated the association between community severance and traffic collisions, as a proxy for road safety, in 2019 in NYC at CBG level.

RESULTS

Our data revealed one multidimensional factor related to community severance explaining 74% of the data variation. In adjusted analyses, traffic collisions in general, and specifically those involving pedestrians or cyclists, were nonlinearly associated with an increasing level of Community Severance Index in NYC.

CONCLUSION

We developed a high spatial-resolution Community Severance Index for NYC using data available nationwide, making it feasible for replication in other cities across the United States. Our findings suggest that increases in the Community Severance Index across CBG may be linked to increases in traffic collisions in NYC. The Community Severance Index, which provides a novel traffic-related exposure, may be used to inform equitable urban policies that mitigate health risks and enhance well-being.

Exploring associations between built environment and crash risk of children in school commuting

Understanding how built environment are associated with crash risk (CR) in school commuting is essential to improving travel safety through land use and transportation policies. Scholars often assume that this relationship is consistent across space, but this may lead to inconsistent estimates. To address this issue, using data in Shenzhen, China, the data covers traffic accident data of children taken from police incident reports and supplemented with local land use, transportation network and specific school information. The measurement model of crash scale was conducted to represent crash severity, and the CR was further quantified. The study applies three models, spatial dubin model (SDM), geographically weighted regression (GWR), and mixed GWR (MGWR), to explore spatio-temporal heterogeneity relationships between built environment attributes and CR of children in school commuting. The findings reveal that the crash scale can better represent crash severity of school commuting than a single indicator. Policy interventions should be targeted at specific spatial scales, school types, and time windows to effectively improve travel safety. However, there are some common findings. It is recommended to use a scale of 200 m to explain the relationship between the variables. The MGWR model outperforms the other two models. To reduce CR, it is important to consider lower road network density, a reasonable layout of educational facilities, fewer bus routes, and more on-street parking spaces. Our findings can help to enrich the understanding of associations between land use and CR of children, as well as offer local planning and operating guidance for creating child-friendly environment.

Cluster analysis of the spatial distribution of pedestrian deaths and injuries by parishes in Kampala city, Uganda

Studies on pedestrian deaths and injuries at the urban level in Africa mostly provide overall aggregated figures and do not examine variation in the sub-urban units. Using cluster analysis, this study sought to determine if the observed pattern in the distribution of pedestrian injuries and deaths among parishes in Kampala city is significant. Pedestrian crash data from 2015 to 2019 were collected from the Uganda Traffic Police database. Serious and fatal pedestrian injury rates were mapped by parish using ArcMap and cluster analyses conducted. Results from spatial autocorrelation (Moran's Index of 0.18 and 0.17 for fatal and serious injury rates respectively) showed that the distributions were clustered within parishes crossed by highways and located in the inner city respectively. Z-scores of 3.32 (p < 0.01) for serious injury rates and 3.71 (p < 0.01) for fatal injury rates indicated that the clustering was not random. This study's main contribution was providing a detailed spatial distribution of pedestrian fatal and serious injury rates for Kampala; a city in a low developing country in Africa at the micro-scale of a parish. This foundational exploratory paper formed the first step of a broader study examining built environment factors explaining this pattern.

Objective and Perceived Traffic Safety for Children: A Systematic Literature Review of Traffic and Built Environment Characteristics Related to Safe Travel

The literature on children’s active transportation has shown the influence of the built environment characteristics on walking and crashes. Various reviews have examined those two questions. One influence on walking is the perception of traffic safety. However, it is not clear how, or even if, the built environment affects such perceptions. This research aims to understand which traffic and built environment characteristics influence objective and subjective/perceived traffic safety for children based on the analysis of previous studies in the field. Two types of research were used: the first examines the association between traffic and built environment characteristics and child pedestrian and/or cyclist collisions/injuries; the second relates to the perception of safety by parents and children for active transportation and, where studied, its relationship with built environment characteristics. A systematic review was conducted using five electronic databases. The total number of articles retrieved was reduced to 38 following the eligibility criteria and quality assessment, where 25 articles relate to injuries among children and 13 articles pertain to perception of safety. The results showed that high traffic volume and high vehicle speed are the main reasons children and parents feel unsafe when children use active travel, which matches the main findings on objective safety. Few articles on perception of safety related to the objective built environment were found. However, consistent findings exist. The presence of sidewalk was related to the safety of children. The presence of a crossing guard was positively related to perceived safety but was associated with higher rates of injuries among children. Intersection density was related to unsafe perceptions but was not statistically associated with objective traffic safety. Additionally, population density was found to be positively related to injuries among children, but not to perception of safety. The results help policy strategy to enhance the safety of children when using active transport modes.

A review of spatial approaches in road safety

Spatial analyses of crashes have been adopted in road safety for decades in order to determine how crashes are affected by neighboring locations, how the influence of parameters varies spatially and which locations warrant interventions more urgently. The aim of the present research is to critically review the existing literature on different spatial approaches through which researchers handle the dimension of space in its various aspects in their studies and analyses. Specifically, the use of different areal unit levels in spatial road safety studies is investigated, different modelling approaches are discussed, and the corresponding study design characteristics are summarized in respective tables including traffic, road environment and area parameters and spatial aggregation approaches. Developments in famous issues in spatial analysis such as the boundary problem, the modifiable areal unit problem and spatial proximity structures are also discussed. Studies focusing on spatially analyzing vulnerable road users are reviewed as well. Regarding spatial models, the application, advantages and disadvantages of various functional/econometric approaches, Bayesian models and machine learning methods are discussed. Based on the reviewed studies, present challenges and future research directions are determined.

Factors related to road system organisation and its association with mortality due to motor vehicle-pedestrian collisions in Guadalajara Metropolitan Area

Introduction

Traffic events are one of the five leading causes of mortality in Mexico. Pedestrians are one of the main road users involved in such incidents and have the highest mortality rate, which is regularly analysed in relation to vehicles and pedestrians, but not the built environment. The purpose of this study was to analyse the elements of the road system organisation that influences the mortality rate of pedestrians hit by motor vehicles in the Guadalajara Metropolitan Area.

Method

We designed a case and control study in which the cases were sites where a pedestrian died during 2012. The controls were sites close to where the death occurred, as well as those with road infrastructure characteristics similar to those where the events took place. We obtained the pedestrian data from the death certificates and assessed some of the environmental elements of the road sites. A logistic regression analysis was used to estimate OR; 95% CI.

Results

Road system factors related with pedestrian mortality in close locations were: the presence of bus stops on intersections in one street or both, and road system features, such as the presence of traffic islands, vehicle flow and pedestrian flow.

Conclusions

According to the urban network theory and multiple theory, the final elements resulted as risk factors due to a fault in connectivity between the nodes. A temporal analysis of urban features will help urban planners make decisions regarding the safety of pedestrians and other road users.

Spatial distribution of roadway environment features related to child pedestrian safety by census tract income in Toronto, Canada

BACKGROUND

Investments in traffic calming infrastructure and other street design features can enhance pedestrian safety as well as contribute to the 'walkability' of neighbourhoods. Pedestrian-motor vehicle collisions (PMVCs) in urban areas, however, remain common and occur more frequently in lower income neighbourhoods. While risk and protective features of roadways related to PMVC have been identified, little research exists examining the distribution of roadway environment features. This study examined the relationship between roadway environment features related to child pedestrian safety and census tract income status in Toronto.

METHODS

Spatial cluster detection based on 2006 census tract data identified low-income and high-income census tract clusters in Toronto. Police-reported PMVC data involving children between the ages of 5 and 14 years were mapped using geographical information system. Also mapped were roadway environment features (densities of speed humps, crossing guards, local roads, one-way streets and missing sidewalks). Multivariate logistic regression was used to examine the relationship between roadway environment features (independent variables) and cluster income status (dependent variable), controlling for child census tract population.

RESULTS

There were significantly fewer speed humps and local roads in low-income versus high-income clusters. Child PMVC rates were 5.4 times higher in low-income versus high-income clusters.

CONCLUSION

Socioeconomic inequities in the distribution of roadway environment features related to child pedestrian safety have policy and process implications related to the safety of child pedestrians in urban neighbourhoods.

Socioeconomic variation in injury hospitalisations in Australian children ≤ 16 years: a 10-year population-based cohort study

BACKGROUND

Childhood injury remains a significant public health problem responsible for significant morbidity and mortality. However, injury has been found to increase with socioeconomic disadvantage for some injuries. The current study examines the 10-year epidemiological profile of injury hospitalisations of children ≤16 years by socioeconomic status for different age group and select types of injury.

METHOD

A retrospective analysis of injury hospitalisations of children aged ≤16 years using linked hospitalisation and mortality records during 1 July 2002 to 30 June 2012 was conducted. Negative binomial regression was used to calculate incidence rate ratios (IRRs) for injury hospitalisation rates by socioeconomic disadvantage quintile.

RESULTS

There were 679,171 injury hospitalisations for children aged 0-16 years in Australia. Children in more disadvantaged socioeconomic quintiles were more likely to be hospitalised for an injury sustained by: assault (IRR range 1.40 to 3.64), poisoning (IRR range 1.29 to 1.36), heat and hot substances (IRR range 1.07 to 1.34), and pedestrian collisions (IRR range 1.06 to 1.54) than children in advantaged socioeconomic quintiles.

CONCLUSIONS

Findings support the notion that the risk of injury hospitalisation among children differs according to socioeconomic gradient and has implications for childhood injury prevention. Policy makers should consider socioeconomic differences in the design of injury prevention measures, particularly measures directed at modifying the built environment and home-based interventions.

Spatial regression analysis of traffic crashes in Seoul

Traffic crashes can be spatially correlated events and the analysis of the distribution of traffic crash frequency requires evaluation of parameters that reflect spatial properties and correlation. Typically this spatial aspect of crash data is not used in everyday practice by planning agencies and this contributes to a gap between research and practice. A database of traffic crashes in Seoul, Korea, in 2010 was developed at the traffic analysis zone (TAZ) level with a number of GIS developed spatial variables. Practical spatial models using available software were estimated. The spatial error model was determined to be better than the spatial lag model and an ordinary least squares baseline regression. A geographically weighted regression model provided useful insights about localization of effects. The results found that an increased length of roads with speed limit below 30 km/h and a higher ratio of residents below age of 15 were correlated with lower traffic crash frequency, while a higher ratio of residents who moved to the TAZ, more vehicle-kilometers traveled, and a greater number of access points with speed limit difference between side roads and mainline above 30 km/h all increased the number of traffic crashes. This suggests, for example, that better control or design for merging lower speed roads with higher speed roads is important. A key result is that the length of bus-only center lanes had the largest effect on increasing traffic crashes. This is important as bus-only center lanes with bus stop islands have been increasingly used to improve transit times. Hence the potential negative safety impacts of such systems need to be studied further and mitigated through improved design of pedestrian access to center bus stop islands.

Breaking Out of Surveillance Silos: Integrative Geospatial Data Collection for Child Injury Risk and Active School Transport

The preponderance of active school transport (AST) and child injury research has occurred independently, yet they are inherently related. This is particularly true in urban areas where the environmental context of AST may pose risks to safety. However, it can be difficult to make these connections due to the often segregated nature in which these veins of research operate. Spatial video presents a geospatial approach for simultaneous data collection related to both issues. This article reports on a multi-sector pilot project among researchers, a children's hospital, and a police department, using spatial video to map child AST behaviors; a geographic information system (GIS) is used to analyze these data in the environmental context of child pedestrian injury and community violence.

Motor-vehicle collisions involving child pedestrians at intersection and mid-block locations

We study motor-vehicle collisions involving child pedestrians walking to school in Hamilton, Ontario, Canada to understand and contrast collision risks at mid-block and intersection locations. We use a matched case-control study design and apply it to intersection and mid-block locations instead of people. Cases are intersections/mid-blocks where collisions occurred and controls are locations where collisions did not occur. We match cases to controls on geography, socio-economic status and year. We use conditional logistic regression to predict the log-odds of collision risk at intersections and mid-blocks as a function of various environmental measures while controlling for volume of child pedestrian activity. Our results suggest that child pedestrian injuries at intersections are associated with intersection control type, traffic volume, and land use characteristics. In contrast, mid-block child pedestrian collisions are not associated with small scale environmental features. The results of this study suggest that some factors associated with the risk of collision differ across location types. These findings may be useful in the planning of safer walking journeys to school.

El estado de las lesiones causadas por el tránsito en México: evidencias para fortalecer la estrategia mexicana de seguridad vial

Mediante la revisión de información secundaria oficial, publicaciones científicas y el análisis de la ENSANut-2012, este trabajo busca proveer una visión integral de la magnitud actual de las lesiones causadas por el tránsito (LCT) en México y analizar críticamente la respuesta social organizada. Las altas tasas de choques, lesiones, muertes y discapacidad atribuidas a este problema de salud pública, representan un elevado costo para la sociedad mexicana, en especial para los hogares. Se discute cómo la respuesta mexicana se ha enfocado a los automovilistas, dejando fuera a usuarios vulnerables de la vía pública y se ha privilegiado la implementación de estrategias poco efectivas. A pesar de que se dispone de legislación para los principales factores de riesgo, se ha descuidado su correcta aplicación. La estrategia mexicana podría fortalecerse implementando estrategias de movilidad seguras, equitativas, saludables y sostenibles para los diferentes actores de la vía pública. A pesar de los avances que se han dado en términos de prevención de LCT, existen aún retos y oportunidades para el país.

Impact of a pilot walking school bus intervention on children's pedestrian safety behaviors: a pilot study

Walking school buses (WSB) increased children's physical activity, but impact on pedestrian safety behaviors (PSB) is unknown. We tested the feasibility of a protocol evaluating changes to PSB during a WSB program. Outcomes were school-level street crossing PSB prior to (Time 1) and during weeks 4-5 (Time 2) of the WSB. The protocol collected 1252 observations at Time 1 and 2548 at Time 2. Mixed model analyses yielded: intervention schoolchildren had 5-fold higher odds (p<0.01) of crossing at the corner/crosswalk but 5-fold lower odds (p<0.01) of stopping at the curb. The protocol appears feasible for documenting changes to school-level PSB.

Neighborhood social inequalities in road traffic injuries: the influence of traffic volume and road design

OBJECTIVES

We examined the extent to which differential traffic volume and road geometry can explain social inequalities in pedestrian, cyclist, and motor vehicle occupant injuries across wealthy and poor urban areas.

METHODS

We performed a multilevel observational study of all road users injured over 5 years (n=19,568) at intersections (n=17,498) in a large urban area (Island of Montreal, Canada). We considered intersection-level (traffic estimates, major roads, number of legs) and area-level (population density, commuting travel modes, household income) characteristics in multilevel Poisson regressions that nested intersections in 506 census tracts.

RESULTS

There were significantly more injured pedestrians, cyclists, and motor vehicle occupants at intersections in the poorest than in the richest areas. Controlling for traffic volume, intersection geometry, and pedestrian and cyclist volumes greatly attenuated the event rate ratios between intersections in the poorest and richest areas for injured pedestrians (-70%), cyclists (-44%), and motor vehicle occupants (-44%).

CONCLUSIONS

Roadway environment can explain a substantial portion of the excess rate of road traffic injuries in the poorest urban areas.

A geographic analysis of collisions involving child pedestrians in a large Southern California county

OBJECTIVES

The goal of this study is to explore the relationship between child pedestrian injuries and socioeconomic characteristics of neighborhoods in the context of local traffic volume.

METHODS

Child pedestrian collisions were identified in the data of the California Statewide Integrated Traffic Records System (SWITRS). Nine hundred sixty crashes over a 5-year period were identified, geocoded, and mapped to Orange County census tracts. Census data from 2000 were used to identify tracts, population, and population characteristics in the county of approximately 3,000,000 individuals. Pedestrian collision maps were merged with census characteristics and analyzed using STATA (Version 10.1, Stata Corp, College Station, IX) to determine correlations between socioeconomic factors and collision rates within census tracts.

RESULTS

The percentage of the population living in households with low income (less than 185% of the federal poverty level) was the strongest predictor of pedestrian injuries. One fourth of census tracts had less than 9 percent of residents with low income and averaged 6 per 100,000 child pedestrian crashes annually. One fourth of the census tracts had more than 32 percent of residents with low income and an average of 56 child pedestrian crashes per 100,000 annually. These data indicate an 8.8-fold increase in collision frequency in the lowest income quartile over the highest income quartile. Other socioeconomic correlates strongly associated with increased child collisions include population density, proportion of population speaking English less than very well, lack of high school education, number of multifamily residences, and Latino ethnicity.

CONCLUSIONS

Our study showed that child pedestrian collisions are nearly 9 times more frequent in the poorest quartile of neighborhoods than in the richest quartile. Other factors associated with increased pediatric collision risk include increased neighborhood crowding, low levels of education and English speaking ability, and Latino ethnicity.

The link between built environment, pedestrian activity and pedestrian-vehicle collision occurrence at signalized intersections

This paper studies the influence of built environment (BE) - including land use types, road network connectivity, transit supply and demographic characteristics - on pedestrian activity and pedestrian-vehicle collision occurrence. For this purpose, a two-equation modeling framework is proposed to investigate the effect of built environment on both pedestrian activity and vehicle-pedestrian collision frequency at signalized intersections. Using accident data of ambulance services in the City of Montreal, the applicability of our framework is illustrated. Different model settings were attempted as part of a model sensitivity analysis. Among other results, it was found that the BE in the proximity of an intersection has a powerful association with pedestrian activity but a small direct effect on pedestrian-vehicle collision frequency. This suggests that the impact of BE is mainly mediated through pedestrian activity. In other words, strategies that encourage densification, mix of land uses and increase in transit supply will increase pedestrian activity and may indirectly, with no supplementary safety strategies, increase the total number of injured pedestrians. In accordance with previous research, the number of motor vehicles entering a particular intersection is the main determinant of collision frequency. Our results show that a 30% reduction in the traffic volume would reduce the total number of injured pedestrians by 35% and the average risk of pedestrian collision by 50% at the intersections under analysis. Major arterials are found to have a double negative effect on pedestrian safety. They are positively linked to traffic but negatively associated with pedestrian activity. The proposed framework is useful for the identification of effective pedestrian safety actions, the prediction of pedestrian volumes and the appropriate safety design of new urban developments that encourage walking.

Child pedestrian casualties and deprivation

The existence of an association between child pedestrian accidents and socio-economic deprivation in Great Britain is well established. The factors driving this association are complex and difficult to isolate. This study uses accident prediction models to investigate the links between child pedestrian casualties and a range of environmental and socio-economic factors commonly linked to deprived areas and people. Separate models are constructed relating to the areas in which the children become casualties, and the areas in which the children reside. Significant socio-economic factors include: single-parenthood, reliance on income support, and crime; and environmental factors include domestic garden area, junction density and pedestrian and vehicular flow density. The study found that factors pertaining to the local environment were more prevalent in the models considering accident locations, whilst socio-economic factors were of greater influence in the residency model.

School-related injuries: a retrospective 5-year evaluation

PURPOSE

Children and adolescents spend up to 50% of their time at school. The purpose of this study was to assess injury patterns of school accidents (along with their treatment) in the trauma center of a German university hospital, and to compare these data to those in the literature.

METHODS

All school accidents treated in a level 1 pediatric trauma center over a five-year period were statistically analyzed in a retrospective manner by chart review.

RESULTS

There were 1,399 school accidents that were treated in our department. Average age of the injured person was 11.8 years, with a boy:girl ratio of 3:2. Almost 40% of the injuries occurred during school sports. The most frequently injured region was the upper extremity, including the hand (36.8%). Distortion and contusion was the most frequent diagnosis among all injuries. Sixteen percent of the cases had to be treated surgically and/or under general anesthesia, and 16% of the patients had to be admitted to the hospital.

CONCLUSION

It can be concluded that special attention must be paid during school sporting activities and breaks because they account for most of the accidents. Traffic education may reduce severe injuries. Specific knowledge of the growing long bones of the upper extremity and the hand is important for the diagnosis and treatment of school accidents.

Evaluating pedestrian crashes in areas with high low-income or minority populations

In this paper, we present an analysis of the relationship between pedestrian-vehicle crashes and characteristics of areas with high low-income and minority populations in the Chicago metropolitan area (also called environmental justice or EJ areas in the United States). While related research has indicated that pedestrian crashes occur more frequently in these areas than in non-EJ areas, this paper attempts to relate the incidence to environmental characteristics and behavioral factors through a better understanding of the contributing factors present in crash occurrences in EJ versus non-EJ areas. Specially constructed small-area factors from a Spatial Decision Support System (SDSS) are used to explain pedestrian-vehicle crashes. Using a Poisson model that corrects for underreporting, we find that pedestrian crash incidents in EJ areas are related to variables of exposure (including the suitability of the area for walking and transit accessibility), crime rates, transit availability, and general population demographics such as income and presence of children. Results suggest that it may be necessary to better incorporate a safety perspective or measures of safety improvements in pedestrian and transit improvements and expansion programs within EJ areas.

Analyzing the effects of place on injury: Does the choice of geographic scale and zone matter?

BACKGROUND

Recent studies have shown that the morbidity and mortality associated with injury of pedestrians are inversely related to socio-economic status (SES). However, in drawing inferences from this association, investigators have paid little attention to the modifiable artifacts related to scale and how the data are partitioned. The purpose of this population-based study was to identify the relation between SES and incidence patterns of pedestrian injury at 4 different geographic scales.

METHODS

We used a Poisson generalized linear model, stratified by age and sex, to analyze the relation between each of 4 area measures of SES and incidence patterns of pedestrian injuries occurring in metropolitan Vancouver between 1 January 2001 and 31 March 2006. The 4 area measures of SES were based on boundaries of dissemination areas, census tracts, custom-defined census tracts (generated by reassignment of dissemination area boundaries by means of a geographic information system) and census subdivisions of the Canadian census. We measured the SES of the location where the injury occurred with the Vancouver Area Neighbourhood Deprivation Index.

RESULTS

A total of 262 injuries in adults (18 years of age or older) were analyzed. Among adult men, the odds ratio (OR) for injury of pedestrians at the scale of dissemination area was 4.93 (95% confidence interval [CI] 2.89-8.42) for areas having the lowest SES relative to those with the highest SES. For the same population, the OR for injury was lower with increasing aggregation of data: 2.33 (95% CI 1.45-3.74) when census tracts were used, 3.26 (95% CI 2.06-5.16) when modified census tracts were used and 1.27 (95% CI 0.47-3.45) when census subdivisions were used. Among adult women, the OR for pedestrian injury by SES was highest at the scale of census subdivision within medium-low SES areas (4.33, 95% CI 1.23-15.22). At the census subdivision scale, the relation between SES and incidence pattern of injury was not consistent with findings at smaller geographic scales, and the OR for injury decreased with each increase in SES.

INTERPRETATION

In this analysis, there was significant variability when different administrative boundaries were applied as proxy measures of the effects of place on incidence patterns of injury. The hypothesized influence of SES on prevalence of pedestrian injury followed a statistically significant socio-economic gradient when analyzed using small-area boundaries of the census. However, researchers should be aware of the inherent variability that remains even among the more homogenous population units.

The relationship of pedestrian injuries to socioeconomic characteristics in a large Southern California County

OBJECTIVES

The goal of this study is to explore the relationship between pedestrian injuries and socioeconomic characteristics.

METHODS

Pedestrian collisions were identified in the data of the California Statewide Integrated Traffic Records System (SWITRS), which is assembled from police crash reports by the California Highway Patrol Information Services Unit. Four thousand crashes were identified and geocoded within the census tracts in a county population of 2,846,289 over a 5-year period. Population and population characteristics for census tracts were obtained from the 2000 U.S. Census.

RESULTS

The percentage of the population living in households with low income (less than 185% of the federal poverty level) was the strongest predictor of pedestrian injuries. One fourth of census tracts had less than 8.7 percent of residents with low income and averaged 11 per 100,000 pedestrian crashes annually. One fourth of the census tracts had more than 32.2 percent of residents with low income and an average of 44 pedestrian crashes per 100,000 annually. Negative binomial regression showed that with each 1 percent increase in the percentage of residents with low income was associated with a 2.8 percent increase in pedestrian crashes. The percentage of residents age 14 years or less, adult residents who had not completed high school, residents who spoke English less than "very well" and spoke another language at home, and the population density were each associated with a higher frequency of pedestrian crashes. However, when low income was added to these 4 regression models, the relationship between low income and pedestrian crashes increased.

CONCLUSIONS

Our study showed that pedestrian crashes are 4 times more frequent in poor neighborhoods and that neither age of the population, education, English language fluency, nor population density explained the effect of poverty.

Drinking, driving, and crashing: a traffic-flow model of alcohol-related motor vehicle accidents

OBJECTIVE

This study examined the influence of on-premise alcohol-outlet densities and of drinking-driver densities on rates of alcohol-related motor vehicle crashes. A traffic-flow model is developed to represent geographic relationships between residential locations of drinking drivers, alcohol outlets, and alcohol-related motor vehicle crashes.

METHOD

Cross-sectional and time-series cross-sectional spatial analyses were performed using data collected from 144 geographic units over 4 years. Data were obtained from archival and survey sources in six communities. Archival data were obtained within community areas and measured activities of either the resident population or persons visiting these communities. These data included local and highway traffic flow, locations of alcohol outlets, population density, network density of the local roadway system, and single-vehicle nighttime (SVN) crashes. Telephone-survey data obtained from residents of the communities were used to estimate the size of the resident drinking and driving population.

RESULTS

Cross-sectional analyses showed that effects relating on-premise densities to alcohol-related crashes were moderated by highway trafficflow. Depending on levels of highway traffic flow, 10% greater densities were related to 0% to 150% greater rates of SVN crashes. Time-series cross-sectional analyses showed that changes in the population pool of drinking drivers and on-premise densities interacted to increase SVN crash rates.

CONCLUSIONS

A simple traffic-flow model can assess the effects of on-premise alcohol-outlet densities and of drinking-driver densities as they vary across communities to produce alcohol-related crashes. Analyses based on these models can usefully guide policy decisions on the sitting of on-premise alcohol outlets.

Adult pedestrian behavior when accompanying children on the route to school

OBJECTIVE

Pedestrian injuries are a major cause of morbidity and mortality to children, especially boys. Adults serve as pedestrian role models and provide learning opportunities for children when walking to school. The research objectives were to investigate adult pedestrian behavior when accompanying boys and girls.

METHODS

Behavioral observation of 140 adult pedestrians accompanying 4- to 9-year-old children was done in British residential locations. Observations took place at light-controlled crossings, speed-restricted school safety zones, and mid-block unmarked crossing sites. Behaviors observed included stopping at the curb, waiting at the curb, looking left and right before and during road crossing, holding hands, talking, and walking straight across.

RESULTS

In general, adults modeled safe road crossing behaviors. Adult safe behavior scores were higher when accompanying girls than when accompanying boys. No statistically significant differences were found by child age group. The fewest safe pedestrian behaviors were observed at light-controlled crossings.

CONCLUSIONS

Adult pedestrians behave differently when with boys and girls and at different types of road crossing site. Interventions aimed at reducing pedestrian injuries to children may need to take these different everyday experiences into consideration.

GIS and injury prevention and control: history, challenges, and opportunities

Intentional and unintentional injury is the leading cause of death and potential years of life lost in the first four decades of life in industrialized countries around the world. Despite surgical innovations and improved access to emergency care, research has shown that certain populations remain particularly vulnerable to the risks and consequences of injury. Recent evidence has shown that the analytical, data linkage, and mapping tools of geographic information systems (GIS) technology provide can further address these determinants and identify populations in need. This paper traces the history of injury prevention and discusses current and future challenges in furthering our understanding of the determinants of injury through the use of GIS.

Encouraging walking for transport and physical activity in children and adolescents: how important is the built environment?

In the post-World War II era, there have been dramatic changes to the environment that appear to be having a detrimental impact on the lifestyles and incidental physical activities of young people. These changes are not trivial and have the potential to influence not only physical health, but also mental health and child development. However, the evidence of the impact of the built environment on physical activity to date is inconsistent. This review examines the evidence on the association between the built environment and walking for transport as well as physical activity generally, with a focus on methodological issues that may explain inconsistencies in the literature to date. It appears that many studies fail to measure behaviour-specific environmental correlates, and insufficient attention is being given to differences according to the age of study participants. Higher levels of out-of-school-hours physical activity and walking appear to be significantly associated with higher levels of urban density and neighbourhoods with mixed-use planning, especially for older children and adolescents. Proximate recreational facilities also appear to predict young people's level of physical activity. However, there are inconsistencies in the literature involving studies with younger children. Independent mobility increases with age. For younger children, the impact of the built environment is influenced by the decision-making of parents as the gatekeepers of their behaviour. Cross-cultural differences may also be present and are worthy of greater exploration. As children develop and are given more independent mobility, it appears that the way neighbourhoods are designed - particularly in terms of proximity and connectivity to local destinations, including schools and shopping centres, and the presence of footpaths - becomes a determinant of whether children are able, and are permitted by their parents, to walk and use destinations locally. If older children and adolescents are to enjoy health and developmental benefits of independent mobility, a key priority must be in reducing exposure to traffic and in increasing surveillance on streets (i.e. 'eyes-on-the-street') through neighbourhood and building design, by encouraging others to walk locally, and by discouraging motor vehicle use in favour of walking and cycling. Parents need to be assured that the rights and safety of pedestrians (and cyclists) - particularly child pedestrians and cyclists - are paramount if we are to turn around our 'child-free streets', now so prevalent in contemporary Australian and US cities. There remains a need for more age- and sex-specific research using behaviour- and context-specific measures, with a view to building a more consistent evidence base to inform future environmental interventions.

Geocoding police collision report data from California: a comprehensive approach

BACKGROUND

Collision geocoding is the process of assigning geographic descriptors, usually latitude and longitude coordinates, to a traffic collision record. On California police reports, relative collision location is recorded using a highway postmile marker or a street intersection. The objective of this study was to create a geocoded database of all police-reported, fatal and severe injury collisions in the California Statewide Integrated Traffic Records System (SWITRS) for years 1997-2006 for use by public agencies.

RESULTS

Geocoding was completed with a multi-step process. First, pre-processing was performed using a scripting language to clean and standardize street name information. A state highway network with postmile values was then created using a custom tool written in Visual Basic for Applications (VBA) in ArcGIS software. Custom VBA functionality was also used to incorporate the offset direction and distance. Intersection and address geocoding was performed using ArcGIS, StreetMap Pro 2003 digital street network, and Google Earth Pro. A total of 142,007 fatal and severe injury collisions were identified in SWITRS. The geocoding match rate was 99.8% for postmile-coded collisions and 86% for intersection-coded collisions. The overall match rate was 91%.

CONCLUSIONS

The availability of geocoded collision data will be beneficial to clinicians, researchers, policymakers, and practitioners in the fields of traffic safety and public health. Potential uses of the data include studies of collision clustering on the highway system, examinations of the associations between collision occurrence and a variety of variables on environmental and social characteristics, including housing and personal demographics, alcohol outlets, schools, and parks. The ability to build maps may be useful in research planning and conduct and in the delivery of information to both technical and non-technical audiences.

Environmental characteristics associated with pedestrian-motor vehicle collisions in Denver, Colorado

OBJECTIVES

We examined patterns of pedestrian-motor vehicle collisions and associated environmental characteristics in Denver, Colorado.

METHODS

We integrated publicly available data on motor vehicle collisions, liquor licenses, land use, and sociodemographic characteristics to analyze spatial patterns and other characteristics of collisions involving pedestrians. We developed both linear and spatially weighted regression models of these collisions.

RESULTS

Spatial analysis revealed global clustering of pedestrian-motor vehicle collisions with concentrations in downtown, in a contiguous neighborhood, and along major arterial streets. Walking to work, population density, and liquor license outlet density all contributed significantly to both linear and spatial models of collisions involving pedestrians and were each significantly associated with these collisions.

CONCLUSIONS

These models, constructed with data from Denver, identified conditions that likely contribute to patterns of pedestrian-motor vehicle collisions. Should these models be verified elsewhere, they will have implications for future research directions, public policy to enhance pedestrian safety, and public health programs aimed at decreasing unintentional injury from pedestrian-motor vehicle collisions and promoting walking as a routine physical activity.

Pedestrian injury and the built environment: an environmental scan of hotspots

Background

Pedestrian injury frequently results in devastating and costly injuries and accounts for 11% of all road user fatalities. In the United States in 2006 there were 4,784 fatalities and 61,000 injuries from pedestrian injury, and in 2007 there were 4,654 fatalities and 70,000 injuries. In Canada, injury is the leading cause of death for those under 45 years of age and the fourth most common cause of death for all ages Traumatic pedestrian injury results in nearly 4000 hospitalizations in Canada annually. These injuries result from the interplay of modifiable environmental factors. The objective of this study was to determine links between the built environment and pedestrian injury hotspots in Vancouver.

Methods

Data were obtained from the Insurance Corporation of British Columbia (ICBC) for the 6 year period from 2000 to 2005 and combined with pedestrian injury data extracted from the British Columbia Trauma Registry (BCTR) for the same period. High incident locations (hotspots) for pedestrian injury in the City of Vancouver were identified and mapped using geographic information systems (GIS), and the characteristics of the built environment at each of the hotspot locations were examined by a team of researchers.

Results

The analysis highlighted 32 pedestrian injury hotspot locations in Vancouver. 31 of 32 hotspots were situated on major roads. Likewise, the majority of hotspots were located on downtown streets. The 'downtown eastside' was identified as an area with multiple high-incident locations, including the 2 highest ranked pedestrian injury hotspots. Bars were present at 21 of the hotspot locations, with 11 of these locations being judged to have high alcohol establishment density.

Conclusion

This study highlighted the disproportionate burden of pedestrian injury centred on the downtown eastside area of Vancouver. The environmental scan revealed that important passive pedestrian safety countermeasures were only present at a minority of high-incident locations. More importantly, bars were highly associated with risk of pedestrian injury. This study is the basis for potential public health intervention by clearly indicating optimal locations for signalized pedestrian crosswalks.

An area-level model of vehicle-pedestrian injury collisions with implications for land use and transportation planning

There is growing awareness among urban planning, public health, and transportation professionals that design decisions and investments that promote walking can be beneficial for human and ecological health. Planners need practical tools to consider the impact of development on pedestrian safety, a key requirement for the promotion of walking. Simple bivariate models have been used to predict changes in vehicle-pedestrian injury collisions based on changes in traffic volume. We describe the development of a multivariate, area-level regression model of vehicle-pedestrian injury collisions based on environmental and population data in 176 San Francisco, California census tracts. Predictor variables examined included street, land use, and population characteristics, including commute behaviors. The final model explained approximately 72% of the systematic variation in census-tract vehicle-pedestrian injury collisions and included measures of traffic volume, arterial streets without transit, land area, proportion of land area zoned for neighborhood commercial and residential-neighborhood commercial uses, employee and resident populations, proportion of people living in poverty and proportion aged 65 and older. We have begun to apply this model to predict area-level change in vehicle-pedestrian injury collisions associated with land use development and transportation planning decisions.

Comparison of Poisson and Bernoulli spatial cluster analyses of pediatric injuries in a fire district

Background

With limited resources available, injury prevention efforts need to be targeted both geographically and to specific populations. As part of a pediatric injury prevention project, data was obtained on all pediatric medical and injury incidents in a fire district to evaluate geographical clustering of pediatric injuries. This will be the first step in attempting to prevent these injuries with specific interventions depending on locations and mechanisms.

Results

There were a total of 4803 incidents involving patients less than 15 years of age that the fire district responded to during 2001–2005 of which 1997 were categorized as injuries and 2806 as medical calls. The two cohorts (injured versus medical) differed in age distribution (7.7 ± 4.4 years versus 5.4 ± 4.8 years, p < 0.001) and location type of incident (school or church 12% versus 15%, multifamily residence 22% versus 13%, single family residence 51% versus 28%, sport, park or recreational facility 3% versus 8%, public building 8% versus 7%, and street or road 3% versus 30%, respectively, p < 0.001). Using the medical incident locations as controls, there was no significant clustering for environmental or assault injuries using the Bernoulli method while there were four significant clusters for all injury mechanisms combined, 13 clusters for motor vehicle collisions, one for falls, and two for pedestrian or bicycle injuries. Using the Poisson cluster method on incidence rates by census tract identified four clusters for all injuries, three for motor vehicle collisions, four for fall injuries, and one each for environmental and assault injuries. The two detection methods shared a minority of overlapping geographical clusters.

Conclusion

Significant clustering occurs overall for all injury mechanisms combined and for each mechanism depending on the cluster detection method used. There was some overlap in geographic clusters identified by both methods. The Bernoulli method allows more focused cluster mapping and evaluation since it directly uses location data. Once clusters are found, interventions can be targeted to specific geographic locations, location types, ages of victims, and mechanisms of injury.

Geo-spatial and log-linear analysis of pedestrian and bicyclist crashes involving school-aged children

PROBLEM

There is a growing concern with the safety of school-aged children. This study identifies the locations of pedestrian/bicyclist crashes involving school-aged children and examines the conditions when these crashes are more likely to occur.

METHOD

The 5-year records of crashes in Orange County, Florida where school-aged children were involved were used. The spatial distribution of these crashes was investigated using the Geographic Information Systems (GIS) and the likelihoods of crash occurrence under different conditions were estimated using log-linear models.

RESULTS

A majority of school-aged children crashes occurred in the areas near schools. Although elementary school children were generally very involved, middle and high school children were more involved in crashes, particularly on high-speed multi-lane roadways. Driver's age, gender, and alcohol use, pedestrian's/bicyclist's age, number of lanes, median type, speed limits, and speed ratio were also found to be correlated with the frequency of crashes.

DISCUSSION

The result confirms that school-aged children are exposed to high crash risk near schools. High crash involvement of middle and high school children reflects that middle and high schools tend to be located near multi-lane high-speed roads.

IMPACT ON INDUSTRY

The pedestrian's/bicyclist's demographic factors and geometric characteristics of the roads adjacent to schools associated with school children's crash involvement are of interest to school districts.

Analysis of injury- and violence-related fatalities in the Ohio Medicaid population: identifying opportunities for prevention

BACKGROUND

To identify the leading causes of injury- and violence-related deaths in demographic subgroups of the population in Ohio, by Medicaid status.

METHODS

We used linked Ohio Medicaid and death certificate files, 1992 to 1998, and obtained the probability (p) of dying from a specific mechanism of injury--given death from injury--by Medicaid status, using multinomial multivariable logistic regression analysis. Probabilities were rank-ordered to identify the leading causes of death in each subgroup.

RESULTS

The leading cause of injury-related deaths was homicide among Medicaid decedents in the age groups 0 to 4, 15 to 24, and 25 to 44 (p = 0.283, 0.380, and 0.269, respectively), and motor vehicle crashes among nonMedicaid decedents aged 5 to 14, 15 to 24, 25 to 44, and 45 to 74 (p = 0.448, 0.462, 0.293, and 0.293, respectively). Accidental falls ranked first among the elderly (p = 0.593 and 0.414, respectively in Medicaid and nonMedicaid decedents). Suicide and accidental exposure to smoke, fire, and flames also ranked high among the leading causes of injury-related deaths in many population subgroups.

CONCLUSIONS

Findings from this study, pointing to the vulnerability of population subgroups to certain mechanisms of injury, can be used to formulate targeted prevention strategies.

Epidemiology of child pedestrian casualty rates: can we assume spatial independence?

Child pedestrian injuries are often investigated by means of ecological studies, yet are clearly part of a complex spatial phenomena. Spatial dependence within such ecological analyses have rarely been assessed, yet the validity of basic statistical techniques rely on a number of independence assumptions. Recent work from Canada has highlighted the potential for modelling spatial dependence within data that was aggregated in terms of the number of road casualties who were resident in a given geographical area. Other jurisdictions aggregate data in terms of the number of casualties in the geographical area in which the collision took place. This paper contrasts child pedestrian casualty data from Devon County UK, which has been aggregated by both methods. A simple ecological model, with minimally useful covaraties relating to measures of child deprivation, provides evidence that data aggregated in terms of the casualty's home location cannot be assumed to be spatially independent and that for analysis of these data to be valid there must be some accounting for spatial auto-correlation within the model structure. Conversely, data aggregated in terms of the collision location (as is usual in the UK) was found to be spatially independent. Whilst the spatial model is clearly more complex it provided a superior fit to that seen with either collision aggregated or non-spatial models. Of more importance, the ecological level association between deprivation and casualty rate is much lower once the spatial structure is accounted for, highlighting the importance using appropriately structured models.