An international study of the exposure of children to traffic

Child pedestrian and cyclist injuries, and the built and social environment across Canadian cities: the Child Active Transportation Safety and the Environment Study (CHASE)

Introduction

Traffic injury is a leading and preventable cause of child death and disability, with child pedestrians and cyclists particularly vulnerable. Examining built environment correlates of child pedestrian and cyclist motor vehicle collisions (PCMVC) in different settings is needed to promote an evidence-based approach to road safety.

Methods

We conducted a cross-sectional study across multiple urban/suburban environments in Canada (Calgary, Toronto, Montreal, Laval, Peel Region). All public elementary schools were included (n=1030). We examined the role of land use/social environments, road environments and traffic safety interventions on the rates of child PCMVC within 1000 m of schools. Multivariable negative binomial regression was conducted for all cities and by individual city. In a subset of schools (n=389), we examined associations when controlling for active school transportation (AST).

Results

Mean PCMVC rate per school ranged from 0.13 collisions/year in Peel to 0.35 in Montreal. Child PCMVC were correlated with land use, social and road environments and traffic safety interventions. In fully adjusted models, social and land use features remained the most important correlates. New immigrant population had the largest positive association with child PCMVC (incidence rate ratio (IRR): 1.26, 95% CI 1.06 to 1.50), while old housing (pre-1960) density was most protective (IRR: 0.83, 95% CI 0.77 to 0.90). AST was associated with PCMVC, but it had no effect on the relationships between PCMVC and other social/environmental correlates.

Conclusion

The built environment and social factors influence rates of child PCMVC. Opportunities to reduce child PCMVC exist through modifications to city design and road environments and implementing traffic safety interventions.

Cyclist-vehicle crash modeling with measurement error in traffic exposure

Exposure measures are always among the explanatory variables of any crash model. Regardless of the technique used to model crash, the mean crash frequency will increase with an increase in exposure since more crashes are likely to occur at higher exposure. For cyclist-vehicle crash models, bike and vehicle exposure measures are essential for an accurate and reliable estimate of the cyclist crash risk. However, traffic exposure measures are an example of variables that are measured with error. Generally, measurement error in regression estimates has three effects: 1) produce bias in parameter estimation for statistical models, 2) lead to a loss of explanation power, 3) mask important features of the data. This study proposes a full Bayesian Poisson Lognormal crash models that account for measurement error in traffic exposure measures (i.e., Vehicle Kilometers Travelled and Bike Kilometers Travelled). The underlying approach is to adjust the traffic exposure measures for measurement error to improve the accuracy of the crash model and crash model estimates. The full Bayesian models are developed using data for 134 traffic analysis zones (TAZs) in the city of Vancouver, Canada. The results show that Poisson Lognormal models that account for measurement error have a better fit for the modeled cyclist-vehicle crash data compared to traditional Poisson Lognormal models. The estimates of the Poisson Lognormal model that accounts for measurement error are consistent, with traditional Poisson Lognormal models' estimates except for the BKT and VKT estimates. Estimates of the BKT and VKT increased after introducing measurement error, which indicates an underestimation (downward bias) to BKT and VKT estimates in case of overlooking measurement error.

Keeping Children Safe

The aim of this article is to present qualitative data from a study of mothers on a housing estate in Leeds, UK, enabling them to voice their concerns about child safety. The estate contains many environmental hazards, from traffic, ‘drugusers’, ‘strangers’ and litter. A high profile given to the vulnerability of children in public places has resulted in parents becoming ever vigilant and subjecting children to increased surveillance, in the face of a lack of environmental measures which would support their efforts to keep children safe. There are costs to parents in time and activities foregone. Moreover, the emphasis on the key role of parents in child safety and the perception of increasing hazards to children is affecting parents' psychological well-being. The article attempts to place parents' concerns within a social context which may begin to explain parental behaviour and anxieties.

Exposure measurement in bicycle safety analysis: A review of the literature

BACKGROUND

Cycling, as an active mode of transportation, has well-established health benefits. However, the safety of cyclists in traffic remains a major concern. In-depth studies of potential risk factors and safety outcomes are needed to ensure the most appropriate actions are taken to improve safety. However, the lack of reliable exposure data hinders meaningful analysis and interpretation. In this paper, we review the bicycle safety literature reporting different methods for measuring cycling exposure and discuss their findings.

METHODS

A literature search identified studies on bicycle safety that included a description of how cycling exposure was measured, and what exposure units were used (e.g. distance, time, trips). Results were analyzed based on whether retrospective or prospective measurement of exposure was used, and whether safety outcomes controlled for exposure.

RESULTS

We analyzed 20 papers. Retrospective studies were dominated by major bicycle accidents, whereas the prospective studies included minor and major bicycle accidents. Retrospective studies indicated higher incidence rates (IR) of accidents for men compared to women, and an increased risk of injury for cyclists aged 50 years or older. There was a lack of data for cyclists younger than 18 years. The risk of cycling accidents increased when riding in the dark. Wearing visible clothing or a helmet, or having more cycling experience did not reduce the risk of being involved in an accident. Better cyclist-driver awareness and more interaction between car driver and cyclists, and well maintained bicycle-specific infrastructure should improve bicycle safety.

CONCLUSION

The need to include exposure in bicycle safety research is increasingly recognized, but good exposure data are often lacking, which makes results hard to interpret and compare. Studies including exposure often use a retrospective research design, without including data on minor bicycle accidents, making it difficult to compare safety levels between age categories or against different types of infrastructure. Future research should focus more on children and adolescents, as this age group is a vulnerable population and is underrepresented in the existing literature.

Preventing Child Pedestrian Injury: A Guide for Practitioners

Each year, an estimated 270,000 pedestrians die from road traffic-related injuries, (worldwide) and children are among the most vulnerable. Child pedestrian injuries occur primarily in residential areas, often on the same street or in close proximity to the child's home, and 90% of injured child pedestrians are unaccompanied by an adult at the time of the injury. The cause of these injuries is a complex combination of factors related not only to characteristics of the child but also the built environment, the road configuration, features of the motor vehicle that might reduce injury, and driver behavior. Accordingly, effective interventions must incorporate education, technology, and improved infrastructure. The medical practitioner can not only provide the necessary education but can also be a powerful voice for changes in pedestrian infrastructure that make walking safer. This article explores the current state of childhood pedestrian injuries using examples from the United States and Australia. Pedestrian interventions and the role that primary care and lifestyle practitioners play in promoting safe pedestrian behaviors among their patients and their families are discussed.

Motor vehicle-pedestrian collisions and walking to school: the role of the built environment

OBJECTIVES

Initiatives to increase active school transportation are popular. However, increased walking to school could increase collision risk. The built environment is related to both pedestrian collision risk and walking to school. We examined the influence of the built environment on walking to school and child pedestrian collisions in Toronto, Canada.

METHODS

Police-reported pedestrian collision data from 2002 to 2011 for children ages 4 to 12, proportion of children walking to school, and built environment data were mapped onto school attendance boundaries. Collision rates were calculated by using 2006 census populations and modeled by using negative binomial regression.

RESULTS

There were 481 collisions with a mean collision rate of 7.4/10 000 children per year. The relationship between walking proportion and collision rate was not statistically significant after adjusting for population density and roadway design variables including multifamily dwelling density, traffic light, traffic calming and 1-way street density, school crossing guard presence, and school socioeconomic status.

CONCLUSIONS

Pedestrian collisions are more strongly associated with built environment features than with proportions walking. Road design features were related to higher collision rates and warrant further examination for their safety effects for children. Future policy designed to increase children's active transportation should be developed from evidence that more clearly addresses child pedestrian safety.

Why more male pedestrians die in vehicle-pedestrian collisions than female pedestrians: a decompositional analysis

OBJECTIVE

Pedestrians account for a third of the 1.2 million traffic fatalities annually worldwide, and men are overrepresented. We examined the factors that contribute to this male-female discrepancy: walking exposure (kilometres walked per person-year), vehicle-pedestrian collision risk (number of collisions per kilometres walked) and vehicle-pedestrian collision case fatality rate (number of deaths per collision).

DESIGN

The decomposition method quantifies the relative contributions (RCs) of individual factors to death rate ratios among groups. The male-female ratio of pedestrian death rates can be expressed as the product of three component ratios: walking exposure, collision risk and case fatality rate. Data sources included the 2008-2009 US Fatality Analysis Reporting System, General Estimates System, National Household Travel Survey and population estimates.

SETTING

USA.

PARTICIPANTS

Pedestrians aged 5 years and older.

MAIN OUTCOME MEASURES

Death rate per person-year, kilometres walked per person-year, collisions per kilometres walked and deaths per collision by sex.

RESULTS

The pedestrian death rate per person-year for men was 2.3 times that for women. This ratio of male to female rates can be expressed as the product of three component ratios: 0.995 for walking exposure, 1.191 for collision risk and 1.976 for case fatality rate. The RCs of these components were 1%, 20% and 79%, respectively.

CONCLUSIONS

The majority of the male-female discrepancy in 2008-2009 pedestrian deaths in the US is attributed to a higher fatality per collision rate among male pedestrians.

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.

Controlling factors of the parental safety perception on children's travel mode choice

The travel mode of children changed significantly over the last 20 years, with a decrease of children travelling as pedestrians or cyclists. This study focuses on six to twelve year old children. Parents determine to a large extent the mode choice of children in this age category. Based on the analysis of an extensive survey, the research shows that traffic infrastructure has a significant impact on parental decision making concerning children's travel mode choice, by affecting both the real and the perceived traffic safety. Real traffic safety is quantified in terms of numbers of accidents and road infrastructure. For the perceived traffic safety a parental allowance probability is calculated per road type to show that infrastructure characteristics influence parental decision making on the children's mode choice. A binary logistic model shows that this allowance is determined by age, gender and traffic infrastructure near the child's home or near destinations frequently visited by children. Since both real and perceived traffic safety are influenced by infrastructure characteristics, a spatial analysis of parental perception and accident statistics can be used to indicate the locations where infrastructure improvements will be most effective to increase the number of children travelling - safely - as pedestrians or cyclists.

An Analysis of Distance from Collision Site to Pedestrian Residence in Pedestrian versus Automobile Collisions Presenting to a Level 1 Trauma Center

This study tests the hypothesis that most pedestrian collisions occur near victims' homes. Patients involved in automobile versus pedestrian collisions who presented to the emergency department at a Level I trauma center between January 2000 and December 2009 were included in the study. Patient demographics were obtained from the trauma registry. Home address was determined from hospital records, collision site was determined from the paramedic run sheet, and the shortest walking distance between the collision site and pedestrian residence was determined using Google Maps. We summarized distances for groups with the median and compared groups using the Kruskal-Wallis rank test. We identified 1917 pedestrian injury cases and identified both residence address and collision location for 1213 cases (63%). Forty-eight percent of the collisions were near home (within 1.1 km, 95% CI 45-51%). Median distance from residence to collision site was 1.4 km (interquartile range 0.3-7.4 km). For ages 0-17, the median distance 0.7 km, and 59% (95% CI 54-63%) of collisions occurred near home. For ages 65 and older, the median distance was 0.6 km and 65% (95% CI 55-73%) were injured near home. Distance did not differ by sex, race, ethnicity, or blood alcohol level. More severe injuries (Injury Severity Score ≥ 16) occurred further from home than less severe injuries (median 1.9 km vs. 1.3 km, p=.01). Patients with a hospital stay of 3 days or less were injured closer to home (median 1.3 km) than patients with a hospital stay of 4 days or more (median 1.8 km, p=.001). Twenty-two percent were injured within the same census tract as their home, 22% on the boundary of their home census tract, and 55% in a different census tract.

L’enfant et la ville : notes introductoires

La relation entre l’enfant et la ville suscite l’intérêt grandissant des praticiens et chercheurs de diverses disciplines à travers le monde. Cette introduction propose de resituer les analyses contemporaines à la croisée de l’évolution des transformations urbaines et des changements dans les représentations de l’enfance. Se dessinent notamment des correspondances entre les diverses perspectives théoriques du rapport personne-environnement et la manière de concevoir l’enfant. Ainsi, la passivité des individus, implicite dans l’approche de disjonction, évoque la vision déterministe de l’enfance : on se préoccupe alors des effets de la ville sur une population « sans défense ». L’approche de conjonction présente au contraire l’enfant comme un acteur dynamique et conduit à explorer la ville au travers de son regard. Ce changement de posture amène les chercheurs et les praticiens à chercher à comprendre et à façonner avec les enfants leur milieu de vie. Par une brève présentation des contributions des collaborateurs à ce numéro, les auteurs signalent les principaux enjeux qui se dégagent des analyses autour de la mobilité des écoliers du primaire d’un point de vue urbanistique, de la socialisation au risque routier chez les enfants d’un point de vue psychologique, de la prise en compte des adolescents lors de l’aménagement des quartiers, des stratégies de survie de jeunes travailleurs ambulants dans le contexte urbain d’un pays en développement et de l’impact d’un dispositif d’apaisement de la circulation sur l’autonomie des enfants du point de vue de la géographie urbaine.

Travel patterns to school among children with asthma

BACKGROUND

Active commuting to school provides regular exercise, which can improve asthma symptoms. Little is known about how children with asthma travel to school.

OBJECTIVE

To identify travel patterns and parental perceptions surrounding mode of travel to school among children with asthma.

METHODS

Cross-sectional study of 176 children with asthma aged 5 to 15 years. Parents completed questionnaires assessing mode of travel to school, physical activity, asthma control, physician counseling, and factors influencing parental decisions. Data analysis included descriptive and bivariate statistics.

RESULTS

Few (16%) children with asthma actively commute to school. Active travelers lived closer to school, and "distance" was the most frequently reported factor influencing a parent's decision regarding travel mode to school. Parents reported few concerns about pollution and little physician counseling on active travel.

CONCLUSION

Few children with asthma actively travel to school. Asthma-specific concerns do not appear to guide parental decisions on travel mode to school.

Environmental correlates of children's active transportation: a systematic literature review

This systematic review investigated the environmental (physical, economic, socio-cultural and political) correlates of active transportation (AT) among young people aged 5-18 years to better inform the promotion of active living. Greater distance, increasing household income and increasing car ownership are consistently associated with lower rates of AT among children. Having a non-white ethnic background has a convincing positive association with AT. Having recreation facilities and walk or bike paths present are possibly associated with higher rates of AT. Further research requires longitudinal and intervention studies, utilizing multi-level design methodologies and objective measures of environmental attributes.

Validity and reliability of a school travel survey

BACKGROUND

Despite the growing interest in active (ie, nonmotorized) travel to and from school, few studies have explored the measurement properties to assess active travel. We evaluated the criterion validity and test-retest reliability of a questionnaire with a sample of young schoolchildren to assess travel to and from school, including mode, travel companion, and destination after school.

METHODS

To assess test-retest reliability, 54 children age 8 to 11 years completed a travel survey on 2 consecutive school days. To assess criterion validity, 28 children age 8 to 10 years and their parents completed a travel survey on 5 consecutive weekdays.

RESULTS

Test-retest reliability of all questions indicated substantial agreement. The questions on mode of transport, where you will go after school, and how you will get there also displayed substantial agreement between parental and child reports.

CONCLUSIONS

For this population, a questionnaire completed by school-age children to assess travel to and from school, including mode, travel companion, and destination after school, was reliably collected and indicated validity for most items when compared with parental reports.

Personal and environmental factors associated with active commuting to school in Switzerland

OBJECTIVE

To assess whether prevalence of active commuting and regular car trips to school varies across communities and language regions in Switzerland and to determine personal and environmental correlates.

METHODS

During the school year 2004/2005, 1345 parental questionnaires (response rate 65%) of children attending 1st, 4th and 8th grades were completed, 1031 could be linked to a GIS environmental database. A German-speaking, a French-speaking and a bilingual study area were included. Usual mode of transportation and frequency of regular car trips to school were assessed. Associations with personal and environmental factors were evaluated with multivariate regression models.

RESULTS

Seventy-eight percent of the children actively traveled to school. Twelve percent were regularly driven at least once a week by car. Major road crossings and distance were significantly related to usual mode of transportation, but not to regular car trips. Age, daycare attendance, parental safety concerns, number of cars in the household and belonging to French-speaking population were significantly associated with increased regular car trips.

CONCLUSION

Objective predictors are main deciding factors for active commuting to school as main mode of transport whereas personal and lifestyle factors are important factors associated with frequency of car use. Not only objective but also differing cultural attitudes should be considered when promoting non-motorized travel.

Personal, family, social, and environmental correlates of active commuting to school

BACKGROUND

Active commuting to school may be an important opportunity for children to accumulate adequate physical activity for improved cardiovascular risk factors, enhanced bone health, and psychosocial well-being. The purpose of this study was to examine personal, family, social, and environmental correlates of active commuting to school among children.

METHODS

Cross-sectional study of 235 children aged 5 to 6 years and 677 children aged 10 to 12 years from 19 elementary schools in Melbourne, Australia. Self-administered questionnaires were completed by parents, and the older children. The shortest possible routes to school were examined using a geographic information system.

RESULTS

Among both age groups, negative correlates of active commuting to school included parental perception of few other children in the neighborhood and no lights or crossings for their child to use, and an objectively assessed busy road barrier en route to school. In younger children, an objectively assessed steep incline en route to school was negatively associated with walking or cycling to school. Good connectivity en route to school was negatively associated with walking or cycling to school among older children. Among both age groups, children were more likely to actively commute to school if their route was <800 meters. There were no associations with perceived energy levels or enjoyment of physical activity, weight status, or family factors.

CONCLUSIONS

For children, creating child-friendly communities and providing skills to safely negotiate the environment may be important. Environmental correlates of active transport in children and adults may differ and warrant further investigation.

Active commuting to school among NSW primary school children: implications for public health

Regular active commuting by walking/cycling can help maintain an active lifestyle. The frequency, duration and correlates of school active commuting were examined for primary school children in NSW, Australia. Walking/cycling-only and in combination with bus/car were of short duration (median 7 or 4 min, respectively) and their frequency dropped within a short distance (>0.75 km) from school. Apart from distance, child's age, school affiliation and perceived safety, regular walking/cycling (10 trips, 22%) was associated with parents' travel mode to work and with father taking the child to school. Frequent walking/cycling (5 trips, 37%) was associated with child's level of independence and the perceived benefits of active commuting. Behaviour change in this setting requires multi-level strategies.

Geographies of inequality: child pedestrian injury and walking school buses in Auckland, New Zealand

In the face of mounting concern at traffic congestion in the vicinity of schools and the associated risks of child pedestrian injury, the 'walking school bus' (WSB) idea has been rapidly adopted within metropolitan Auckland. WSBs involve volunteers guiding children to and from school in an orderly manner following established walking routes. This paper reports on a survey of the 34 Auckland primary schools which had adopted the scheme by November 2002. Despite rates of child pedestrian injury being highest in areas of socio-economic deprivation, our survey found WSB developments highly concentrated in low deprivation neighbourhoods. The inequitable socio-spatial distribution of WSBs in Auckland suggests that the ability to respond to road safety issues is closely correlated with socio-economic privilege. While our respondents identified a number of individual and community health benefits accruing from WSBs, we conclude that the initiative has a limited ability to address public health challenges originating within an inequitable and car-dominated urban political system.

Exposure to traffic among urban children injured as pedestrians

OBJECTIVES

To explore the immediate pre-crash activities and the routine traffic exposure (street crossing and play) in a sample of urban children struck by automobiles. In particular, the traffic exposure of children who were struck while playing was compared with that of those struck while crossing streets.

DESIGN

Cross sectional survey.

SETTING

Urban pediatric emergency department.

PATIENTS

A total of 139 children ages 4-15 years evaluated for acute injuries resulting from pedestrian-motor vehicle collisions during a 14 month period.

MAIN OUTCOME MEASURES

Sites of outdoor play, daily time in outdoor play, weekly number of street crossings, pre-crash circumstance (play v walking).

RESULTS

Altogether 39% of the children routinely used the street and 64% routinely used the sidewalks as play areas. The median number of street crossings per week per child was 27. There were no differences in exposures for the 29% who were hit while playing compared with the 71% who were hit while walking. Although 84% of the children walked to or from school at least one day per week, only 15% of the children were struck while on the school walking trip. The remainder were injured either while playing outdoors or while walking to other places.

CONCLUSIONS

Urban children who are victims of pedestrian crashes have a high level of traffic exposure from a variety of circumstances related to their routine outdoor playing and street crossing activities. The distributions of traffic exposures were similar across the sample, indicating that the sample as a whole had high traffic exposure, regardless of the children's activity preceding the crash. Future pedestrian injury programs should address the pervasive nature of children's exposure to traffic during their routine outdoor activities.

The safe journeys of an enterprising school: negotiating landscapes of opportunity and risk

In this paper, we discuss recent efforts to improve the safety of children travelling to and from New Zealand's largest primary school. The results of a travel survey completed by parents and pupils are reported, together with our recommendations for reducing congestion at the school gate and promoting healthy alternatives to car travel. Reflecting on this research, we find that market-oriented education reforms have provided schools with strong incentives for increasing their rolls--a course of action which may endanger pupils' well-being. At the same time, they have provided some schools with opportunities for resisting the present urban (dis)order and promoting community health.