Effect of cell phone distraction on pediatric pedestrian injury risk

Safety analysis of pedestrians distracted by mobile phones at street crossings: Field study in Nanjing

The growing public concern over traffic safety hazards caused by pedestrians' distracted behavior, particularly related to mobile phone usage at pedestrian crossings. Through video recording of pedestrians' street-crossing behaviors on 12 sidewalks across 9 urban road intersections in Nanjing city, 1778 valid pedestrian samples were collected. The study categorizes mobile phone use during the crossing into five distinct types: no use, voice call, screen gaze, screen gaze with operation, and listening to music with headphones. Then, the effects of gender, age and companion conditions on the mobile phone during the crossing were examined by chi-square tests. Utilizing binomial logistic and Relogit regression models, the study analyzed the impact and safety risks of distraction on crossing behavior. Additionally, a random parameters (RP) logit model with heterogeneity in means was used to investigate the determinants affecting mobile phone usage. Notably, individuals aged 18 to 30 years were identified as the random parameter, while factors such as being under 18 years old, having a companion without interaction, having a companion with interaction, weekdays, sidewalk length, and the total number of other pedestrians were identified as fixed parameters. The study also presented significant variables affecting the probability of mobile phone usage through marginal effects, highlighting the potential safety risks associated with mobile phone usage during street crossing. These findings emphasize the need for heightened pedestrian safety awareness and a reduction in distracted behaviors to enhance overall traffic safety.

Effects of smartwatch usage on Children's street-crossing behavior and visual attention allocation: An experimental study on street crossing in a real road environment

The use of smartwatches is facilitating the lives of children. However, smartwatch usage while crossing a street may lead to distractions and traffic safety hazards. The purpose of this study was to investigate the effects of smartwatch usage on the street-crossing behavior and visual strategies of children. Twenty-two children were recruited, and 220 street-crossing experiments were performed in real road environments, including at signalized and unsignalized intersections. ANOVA and Kruskal-Wallis H test calibrations were used to analyze the street-crossing behavior between the control group (who performed a task without smartwatch distraction) and the experimental group (who performed four different tasks with smartwatch distraction), and to visualize and compare the visual behavior data of children crossing the street. The results showed that children wearing smartwatches crossed the street more slowly and had a relatively narrow range of visual search, focusing on only a small area of the zebra crossing around them and the crosswalk area within their sight, whereas children who did not wear smartwatches additionally focused on areas with dangerous oncoming traffic on the left and right sides. Children wearing smartwatches were under various mental workloads and distraction levels as they performed the various distracting tasks, with listening to stories being the least distracting and least intensive, followed by answering phone calls and viewing images; a simple arithmetic operation was the most distracting and intensive task. Children while performing the distracting tasks showed a lower street-crossing speed and scanned left and right fewer times; viewing images and performing the simple arithmetic task also increased their fixation time on the smartwatches, further affecting their street-crossing behavior and thus increasing the risk of collision. At signalized intersections, children paid more attention to hazardous oncoming traffic areas and exhibited cautious crossing behaviors compared with that at unsignalized intersections. This study elucidated the characteristics of the effects of smartwatch usage on the street-crossing behavior of children and the influence pattern of the visual attention allocation and revealed the hazards of smartwatch usage on the street-crossing safety. It can contribute to improving the safety cognition of children distracted by smartwatch usage and reducing the occurrence of distracting behaviors while crossing streets. The results can provide a theoretical basis for scientific interventions and safety improvement measures.

Road-Crossing Behavior in Complex Traffic Situations: A Comparison of Children With and Without ADHD

All children are vulnerable to pedestrian injuries, but previous research suggests children diagnosed with ADHD may have elevated risk. Child pedestrian injury risk also increases with increasing traffic volume and speed. The current study examined three hypotheses: (a) Pedestrian behavior of children with ADHD is riskier than that of typically-developing children; (b) Children's pedestrian behavior is riskier with increased traffic complexity; and (c) Pedestrian behavior of children with ADHD is influenced more by complex traffic situations than behavior of typically-developing children. A sample of 38 children ages 8-12 years, 45% diagnosed with ADHD, completed 21 virtual street-crossings, 7 in each of three levels of traffic complexity. Outcome measures included unsafe crossings, ratio of looking at traffic by time, start-delay to enter the road, time to contact with oncoming vehicles, and time waiting to cross. A repeated measure MANOVA and follow-up tests showed that all children had more unsafe crossings, shorter start-delays and shorter TTCs when exposed to increased traffic complexity compared to lighter traffic. Children with ADHD had more unsafe crossings than typically-developing children. Further, compared to typically-developing children, ADHD children had comparatively more unsafe crossings, lower time to contact and longer wait-time in more complex traffic environments. Executive function deficits among children with ADHD likely influence their behavior in complex traffic environments. Implications of the results for policy-making and preventive strategies are discussed.

Someone to Watch Over You: Using Bluetooth Beacons for Alerting Distracted Pedestrians

In the United States, an estimated 7,005 (crude rate 2.13) pedestrians were killed in traffic crashes in 2020, according to the Centers for Disease Control and Prevention (CDC). This statistic is currently increasing annually and research suggests that distraction by smartphones may be a primary reason for the increasing number of pedestrian injuries and deaths. Timely interruptions may alert inattentive pedestrians and prevent fatalities. To this end, we developed StreetBit, a Bluetooth beacon-based system that warns distracted pedestrians with a visual and/or audible interruption when they approach a potentially dangerous traffic intersection while distracted by their smartphones. We posit that by using StreetBit, we can educate distracted pedestrians and elicit behavioral change to reduce or remove smartphone-based distractions when they enter and cross roadways. To demonstrate the feasibility of StreetBit, we conducted a field study with 385 participants. Results show that the system demonstrates adequate feasibility and behavior change in response to the StreetBit program.

Macro-level literature analysis on pedestrian safety: Bibliometric overview, conceptual frames, and trends

Due to the high volume of documents in the pedestrian safety field, the current study conducts a systematic bibliometric analysis on the researches published before October 3, 2021, based on the science-mapping approach. Science mapping enables us to present a broad picture and comprehensive review of a significant number of documents using co-citation, bibliographic coupling, collaboration, and co-word analysis. To this end, a dataset of 6311 pedestrian safety papers was collected from the Web of Science Core Collection database. First, a descriptive analysis was carried out, covering whole yearly publications, most-cited papers, and most-productive authors, as well as sources, affiliations, and countries. In the next steps, science mapping was implemented to clarify the social, intellectual, and conceptual structures of pedestrian-safety research using the VOSviewer and Bibliometrix R-package tools. Remarkably, based on intellectual structure, pedestrian safety demonstrated an association with seven research areas: "Pedestrian crash frequency models", "Pedestrian injury severity crash models", "Traffic engineering measures in pedestrians' safety", "Global reports around pedestrian accident epidemiology", "Effect of age and gender on pedestrians' behavior", "Distraction of pedestrians", and "Pedestrian crowd dynamics and evacuation". Moreover, according to conceptual structure, five major research fronts were found to be relevant, namely "Collision avoidance and intelligent transportation systems (ITS)", "Epidemiological studies of pedestrian injury and prevention", "Pedestrian road crossing and behavioral factors", "Pedestrian flow simulation", and "Walkable environment and pedestrian safety". Finally, "autonomous vehicle", "pedestrian detection", and "collision avoidance" themes were identified as having the greatest centrality and development degrees in recent years.

Risk of Accidents or Chronic Disorders From Improper Use of Mobile Phones: A Systematic Review and Meta-analysis

Background

Mobile phone use has brought convenience, but the long or improper use of mobile phones can cause harm to the human body.

Objective

We aimed to assess the impact of improper mobile phone use on the risks of accidents and chronic disorders.

Methods

We systematically searched in PubMed, EMBASE, Cochrane, and Web of Science databases for studies published prior to April 5, 2019; relevant reviews were also searched to identify additional studies. A random-effects model was used to calculate the overall pooled estimates.

Results

Mobile phone users had a higher risk of accidents (relative risk [RR] 1.37, 95% CI 1.22 to 1.55). Long-term use of mobile phones increased accident risk relative to nonuse or short-term use (RR 2.10, 95% CI 1.63 to 2.70). Compared with nonuse, mobile phone use resulted in a higher risk for neoplasms (RR 1.07, 95% CI 1.01 to 1.14), eye diseases (RR 2.03, 95% CI 1.27 to 3.23), mental health disorders (RR 1.16, 95% CI 1.02 to 1.32), and headaches (RR 1.25, 95% CI 1.18 to 1.32); the pooled risk of other chronic disorders was 1.20 (95% CI 0.90 to 1.59). Subgroup analyses also confirmed the increased risk of accidents and chronic disorders.

Conclusions

Improper use of mobile phones can harm the human body. While enjoying the convenience brought by mobile phones, people have to use mobile phones properly and reasonably.

Child-Pedestrian Traffic Safety at Crosswalks—Literature Review

Child pedestrians make up 30% of the total number of children injured in road traffic in the EU. They are a particularly vulnerable subgroup because they exhibit specific traffic behavior related to cognitive and physical development, sociodemographic characteristics, and environmental conditions. This paper provides an overview of research of parameters that affect the safety of children in the conflict zones of the intersection—crosswalks. The overview was undertaken targeting available research mostly conducted in the last 10 years all over the world, related to the identification of parameters that affect the safety of child-pedestrians, and models developed for the prediction of pedestrian and child-pedestrian behavior. Research conducted on various urban networks provides insight into locally and more widely applicable impact parameters connected to child characteristics and infrastructural and traffic elements, but also distractors (e.g., electronic devices) as new phenomena influencing children’s road safety. A review of pedestrian behavior-prediction models suggests that models are being developed for the general population, and models for children’s behavior, with specific parameters, are missing. For further research, more detailed analysis of the impact of distractors and of COVID–19 pandemic non-mobility, as well as an analysis of possible infrastructural solutions to increase children’s road traffic safety, is suggested.

Meal-time Smartphone Use in an Obesogenic Environment: Two Longitudinal Observational Studies

Background

Despite a large volume of research on the impact of other digital screens (eg, televisions) on eating behavior, little is known about the nature and impact of mealtime smartphone use.

Objective

We investigated how smartphones are used in everyday meals, whether phone users differ according to mealtime phone use patterns, and whether specific phone functions (particularly food photography) would affect the amount and enjoyment of food eaten.

Methods

Across 2 studies, we used the experience sampling method to track 1780 meals in situ. In study 1, a total 137 young adults reported on their mealtime smartphone use 3 times per day over 7 consecutive days. This corresponded to each main meal, with participants recording whether they used their phones and what phone functions they engaged in while eating. In study 2, a total of 71 young adults were similarly tracked for 3 meals per day over 7 days. Across the week, participants’ meals were randomized to 1 of 3 smartphone conditions: food photography while eating, nonfood photography while eating, or no phone use. As the outcome measures, participants reported on the amount and enjoyment of food they ate.

Results

During the week-long tracking, most participants (110/129, 85.3%) recorded at least one instance of mealtime smartphone use, with an average frequency of 1 in 3 meals where phones were used (27.1%; 95% CI 23.6-30.6). Unlike traditional digital screens, mealtime phone use encompassed a wide range of social and nonsocial activities. Further, specific forms of phone use behaviors influenced food intake in different ways. Specifically, in study 2, participants showed the typical pattern of increased food intake across the day when they engaged in nonfood photography during a meal (P<.001); however, this pattern was disrupted when they engaged in food photography (P=.73).

Conclusions

Our findings underscore the prevalence and multifaceted nature of mealtime phone use, distinguishing mobile phones from traditional forms of digital screens.

Trial Registration

ClinicalTrials.gov NCT03299075; https://www.clinicaltrials.gov/ct2/show/NCT03299075 and ClinicalTrials.gov NCT03346785; https://clinicaltrials.gov/ct2/show/NCT03346785

The effects of sleep deprivation and text messaging on pedestrian safety in university students

STUDY OBJECTIVES

This study assesses the impact of sleep deprivation and text messaging on pedestrian injury risk.

METHODS

A total of 36 university students engaged in a virtual reality pedestrian environment in two conditions: sleep deprived (no sleep previous night) and normal sleep (normal sleep routine). Sleep was assessed using actigraphy and pedestrian behavior via four outcomes: time to initiate crossing, time before contact with oncoming vehicle, hits/close calls, and looks left/right. During each condition, participants made half the crossings while text messaging. Participants also completed the Useful Field of View test, the Psychomotor Vigilance Test, and Conners' Continuous Performance Test in both conditions.

RESULTS

While sleep deprived, students crossed significantly closer to oncoming vehicles compared with after normal sleep. While text messaging, crossed closer to vehicles and took longer to initiate crossings. Safety risks were amplified through combined sleep deprivation plus text messaging, leading to more virtual hits and close calls and shorter time before vehicle contact while crossing. Sleep-deprived students demonstrated impairments in functioning on cognitive tests.

CONCLUSIONS

University students' pedestrian behavior was generally riskier, and their cognitive functioning was impaired, when sleep deprived compared with after normal sleep. This effect was exacerbated when distracted by text messaging.

Using Smartphones When Eating Increases Caloric Intake in Young People: An Overview of the Literature

Recent literature highlights that the use of smartphones during meals increases the number of calories ingested in young people. Although the distraction interferes with physiological signals of hunger and satiety, a social facilitation effect has also been suggested. Cognition is a pivotal component in regulating food intake, and activities requiring high perceptual demands should be discouraged during meals.

Feeding in the Digital Age: An Observational Analysis of Mobile Device Use during Family Meals at Fast Food Restaurants in Italy

Caregiver mobile phone use while monitoring children is a behavior of increasing prevalence. Family mealtimes have long been considered a time in which parents and children connect emotionally and model eating behaviors, but prior studies have documented less parent-child conversation and more negative parent reactions to child behavioral bids at the table during parent phone use. Research on this topic to date is sparse and focuses only on US populations. The current study used non-participant naturalistic observation to record data on parental mealtime device use and family interactions while dining with children in a fast food restaurant in Italy. Thirty seven families (individuals observed = 129) were observed at a restaurant for the duration of their meal. Qualitative analysis of field notes indicated that mobile phones are frequently used by caregivers during feeding interactions. A novel observation in the current study was different patterns of use by parent gender and age. Mothers appeared to divide their attention between phone and child, whereas fathers evidenced more continuous mobile phone use during which there was lower responsiveness towards children during the meal. Younger parents more frequently used mobile phones, compared to older parents. Parents who missed child bids for attention were all phone users during the mealtime.

Guidance and surroundings awareness in outdoor handheld augmented reality

Handheld and wearable devices are becoming ubiquitous in our lives and augmented reality technology is stepping out of the laboratory environment and becoming ready to be used by anyone with portable devices. The success of augmented reality applications for pedestrians depends on different factors including a reliable guidance system and preventing risks. We show that different guidance systems can be supplementary to provide directions to a point of interest and offer clues that help the user find the augmented data when they get close to the location they have to visit. We tested the helpfulness of a map with the points of interest, an image preview of the next point of interest to visit, and an arrow showing the direction to it. The results show that the effectiveness of these guidance systems depend on the distance to the point of interest and the accuracy of the data obtained from the Global Positioning System. We also measured the total time that participants spent looking at the screen, as well as the perceived elapsed time as a measurement of real world dissociation. Finally, we discuss preliminary results to minimize the risk of accidents when using augmented reality applications in an outdoor urban environment.

Plight of the distracted pedestrian: a research synthesis and meta-analysis of mobile phone use on crossing behaviour

BACKGROUND

Pedestrians are commonly involved in vehicle collisions that result in injuries and fatalities. Pedestrian distraction has become an emerging safety issue as more pedestrians use their mobile phones while walking and crossing the street.

OBJECTIVES

The purpose of this research synthesis and meta-analysis is to determine the extent to which cell phone conversation, text messaging or browsing, and listening to music affect a number of common pedestrian behavioural measures.

METHODS

A keyword search was developed with a subject librarian that used MeSH terms from selected databases including PsycINFO, SPORTDiscus, Medline and TRID. Supplemental searches were also conducted with Google Scholar and Mendeley.

EFFECT SIZE CODING

Thirty-three studies met inclusion criteria and were subjected to data extraction. Statistical information (ie, M, SD, SE, 95% CI, OR, F, t) was extracted to generate standardised mean difference effect sizes (ie, Cohen's d) and r effect sizes.

RESULTS

Fourteen experimental studies were ultimately included in an N-weighted meta-analysis (k=81 effect sizes), and eight observational studies were included in a qualitative overview. Both mobile phone conversation and text messaging increased rates of hits and close calls. Texting decreased rates of looking left and right prior to and/or during street crossing. As might be expected, text messaging was generally found to have the most detrimental effect on multiple behavioural measures.

LIMITATIONS

A variety of study quality issues limit the interpretation and generalisation of the results, which are described, as are future study measurement and methods improvements.

Pedestrian distraction: The effects of road environment complexity and age on pedestrian's visual attention and crossing behavior

INTRODUCTION

Little is known about how characteristics of the environment affect pedestrians' road crossing behavior.

METHOD

In this work, the effect of typical urban visual clutter created by objects and elements in the road proximity (e.g., billboards) on adults and children (aged 9-13) road crossing behavior was examined in a controlled laboratory environment, utilizing virtual reality scenarios projected on a large dome screen.

RESULTS

Divided into three levels of visual load, results showed that high visual load affected children's and adults' road crossing behavior and visual attention. The main effect on participants' crossing decisions was seen in missed crossing opportunities. Children and adults missed more opportunities to cross the road when exposed to more cluttered road environments. An interaction with age was found in the dispersion of the visual attention measure. Children, 9-10 and 11-13 years old, had a wider spread of gazes across the scene when the environment was highly loaded-an effect not seen with adults. However, unexpectedly, no other indication of the deterring effect was found in the current study. Still, according to the results, it is reasonable to assume that busier road environments can be more hazardous to adult and child pedestrians. Practical Applications: In that context, it is important to further investigate the possible distracting effect of causal objects in the road environment on pedestrians, and especially children. This knowledge can help to create better safety guideline for children and assist urban planners in creating safer urban environments.

Using Bluetooth beacon technology to reduce distracted pedestrian behaviour: a cross-over trial study protocol

OBJECTIVE

Over 6400 American pedestrians die annually, a figure that is currently increasing. One hypothesised reason for the increasing trend is the role of mobile technology in distracting both pedestrians and drivers. Scientists and policy-makers have attended somewhat to distracted driving, but attention to distracted pedestrian behaviour has lagged. We will evaluate Bluetooth beacon technology as a means to alert and warn pedestrians when they approach intersections, reminding them to attend to the traffic environment and cross streets safely.

METHODS

Bluetooth beacons are small devices that broadcast information unidirectionally within a closed proximal network. We will place beacons at an intersection frequently trafficked by urban college students. From there, the beacons will transmit to an app installed on users' smartphones, signalling users to attend to their environment and cross the street safely. A cross-over trial will evaluate the app with 411 adults who frequently cross the target intersection on an urban university campus. We will monitor those participants' behaviour over three distinct time periods: (1) 3 weeks without the app being activated, (2) 3 weeks with the app activated and (3) 4 weeks without the app activated to assess retention of behaviour. Throughout the 10-week period, we will gather information to evaluate whether the intervention changes distracted pedestrian behaviour using a logistic regression to estimate the likelihood of key behavioural outcome measures and adjusting for any residual confounding. We also will test for changes in perceived risk. The trial will follow CONSORT (Consolidated Standards of Reporting Trials) statement guidelines, as modified for cross-over design studies.

CONCLUSION

If this program proves successful, it offers exciting implications for future testing and ultimately for broad distribution to reduce distracted pedestrian behavior. We discuss issues of feasibility, acceptability and scalability.

Heads Up, Phones Down: A Pedestrian Safety Intervention on Distracted Crosswalk Behavior

Cell phone use has been implicated in driver distraction and motor vehicle crashes, and more recently has been associated with distracted pedestrians. There are limited data on interventions aimed at this important public health issue. We hypothesized that the use of a visual intervention near street crossings would decrease the frequency of distracted behaviors of pedestrians. We performed a prospective observational cohort study examining painted sidewalk stencils reading, "Heads Up, Phones Down" as an intervention to decrease cell phone distractions amongst pedestrians. These stenciled messages were placed at a children's hospital, middle school, and high school in Los Angeles County. Anonymous observations of pedestrian distractions (texting, talking on a phone, headphone use, and other) were conducted before, 1 week after, and 4 months after the intervention. Distractions were compared before and after intervention using Chi square tests. A total of 11,533 pedestrians were observed, with 71% children and 29% adults. Total distractions decreased from 23% pre-intervention to 17% 1 week after stencil placement (p < 0.01), but this was not sustained at 4 months (23%, p = 0.4). A sustained decrease was observed only for texting at 4 months post-intervention (8.5% vs. 6.8%, p < 0.01). A simple visual intervention reduced distracted cell phone usage in pedestrians crossing the street, but this was most effective early after the intervention. Future studies are warranted to determine how to sustain this effect over time and how to minimize other types of distractions.

Roles of individual differences and traffic environment factors on children's street-crossing behaviour in a VR environment

OBJECTIVE

Pedestrian injuries are among the most common cause of death and serious injury to children. A range of risk factors, including individual differences and traffic environment factors, has been investigated as predictors of children's pedestrian behaviours. There is little evidence examining how risk factors might interact with each other to influence children's risk, however. The present study examined the independent and joint influences of individual differences (sex and sensation seeking) and traffic environment factors (vehicle speeds and inter-vehicle distances) on children's pedestrian safety.

METHODS

A total of 300 children aged 10-13 years were recruited to complete a sensation-seeking scale, and 120 of those were selected for further evaluation based on having high or low sensation-seeking scores in each gender, with 30 children in each group. Children's pedestrian crossing behaviours were evaluated in a virtual reality traffic environment.

RESULTS

Children low in sensation seeking missed more opportunities to cross and had longer start gaps to enter the roadway compared with those high in sensation seeking, and these effects were more substantial when vehicles were spread further apart but travelling slowly. Interaction effects between inter-vehicle distance and vehicle speed were also detected, with children engaging in riskier crossings when the car was moving more quickly and the vehicles were spread further than when the vehicles were moving quickly but were closer together. No sex differences or interactions emerged.

CONCLUSION

Both sensation seeking and traffic environment factors impact children's behaviour in traffic, and there are interactions between traffic speeds and inter-vehicle distances that impact crossing behaviour.

The Road User Behaviours of Chinese Adolescents: Data From China and a Comparison With Adolescents in Other Countries

OBJECTIVES

Adolescents experience high rates of road traffic injuries and deaths as pedestrians and cyclists. One likely reason for adolescents' elevated traffic injury risk is their risky behaviour on the road. This study examined Chinese adolescents' road behaviour using a nationwide survey.

METHODS

Across 7 Chinese provinces, 4,794 adolescents completed the Chinese version of the Adolescent Road User Behaviour Questionnaire (ARBQ). Results from t-tests and ANOVAs described the road behaviours of Chinese adolescent subgroups, and meta-analytic techniques and Kendall's correlation analysis compared adolescent road behaviours between China and other countries (Iran and a high-income country composite).

RESULTS

Replicating previous reports from other countries, male adolescents in China generally reported more risk-taking on the road than females, and adolescents aged 15 years and over behaved in a riskier manner than younger ones. Adolescents in rural China reported more risky road behaviours than those who lived in cities, and adolescents who lived only with grandparents behaved more riskily than those who lived with parents only or with parents and grandparents. Adolescents previously involved in a traffic injury also reported riskier road behaviours. In cross-national comparisons, Chinese adolescents' scores on unsafe road behaviours were lower, and scores on safe road behaviours were higher, than those in other nations. However, there were also several commonalities in how adolescents across countries ranked the frequency of engaging in specific risky road behaviours.

CONCLUSIONS

Gender, age, living environment, and traffic injury experience affect adolescents' reports of their risky road behaviour. Chinese adolescents reported more cautious behaviour than those in high-income countries and in Iran. Traffic injury interventions for adolescents should consider adolescent development as part of pedestrian safety training; results also have implications for guiding parents on how to supervise adolescents near traffic and on what infrastructure development strategies might best protect adolescents in traffic situations.

Adolescents’ Mobile Phone Use While Crossing the Road

Phones and other portable technology can be a distraction for pedestrians, affecting their ability to cross a road safely. This study focused on adolescents and investigated whether using a phone distracts attention while crossing the road. A field observation outside a secondary school in the north of England was carried out over a four-week period in 2018 with permission from the school. Observations included recording what accessories the pedestrian was carrying (phone, headphones or another electronic device) and their associated action (whether they were holding the device, speaking into a phone, looking at it, holding it to their ear or interacting with it manually). We observed whether the pedestrian looked (or failed to look) left and right before crossing the road, whether they crossed when the pedestrian light was on green or red, and whether they crossed within the cross-walk. We found that 31.37% of road crossings were made by adolescents with a phone or other device. They looked left and right before crossing less frequently when they had an electronic device with them, when looking at the screen and when texting or swiping. In conclusion, the safety of adolescent pedestrians is affected by mobile phones and music players.

Prevalence of distracted walking with mobile technology: an observational study of Calgary and Edmonton high school students

OBJECTIVES

Distracted walking poses a safety concern while crossing roads. A 2014 Canadian survey showed that 51% of teenagers were hit or almost hit while crossing the street, many of whom were distracted by mobile technology. An American study demonstrated that 1 in 5 high school students engaged in distracted walking; however, prevalence estimates in Canada have not been described. This study aimed to obtain a prevalence estimate of distracted walking in high school students in Calgary and Edmonton, Alberta, Canada.

METHODS

Students were observed crossing the street at 20 high schools following afternoon school dismissal times during September to November 2017. Behaviours included talking on mobile phone, using earbuds, looking down at phone, and engaging in more than one of these behaviours. Also recorded were median household income of surrounding neighbourhood, outside temperature, gender, and crosswalk type.

RESULTS

A total of 3553 students were observed, with 666 engaged in distracted walking (18.7%). Females engaged in distracted walking more than males (19.9% vs. 17.6%, respectively). The most prevalent behaviour was using earbuds (66.5%). Males had a lower prevalence of distracted walking compared with females. Distracted walking was more prevalent when the temperature was above 10 °C compared with less than 0 °C and less prevalent at signaled compared with non-signaled intersections.

CONCLUSION

This study demonstrates that approximately 1 in 5 high school students in Calgary and Edmonton, Alberta, Canada, engage in distracted walking behaviours while crossing the street. These results may help raise awareness and inform policy to decrease risk of pedestrian injury.

Exploring patterns of child pedestrian behaviors at urban intersections

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

Harnessing Vehicle-to-Pedestrian (V2P) Communication Technology: Sending Traffic Warnings to Texting Pedestrians

OBJECTIVE

We examined how sending mobile-device warnings to texting pedestrians when they initiate an unsafe road crossing influences their decisions and actions.

BACKGROUND

Pedestrian texting has been identified as a key risk factor in pedestrian-vehicle collisions. Advances in sensing and communications technology offer the possibility of providing pedestrians with information about traffic conditions to assist them in safely crossing traffic-filled roadways. However, it is unclear how this information can be most effectively communicated to pedestrians.

METHOD

We examined how texting and nontexting pedestrians crossed roads with continuous traffic in a large-screen, immersive pedestrian simulator using a between-subjects design with three conditions: texting, warning, and control. Texting participants in the warning condition received an alarm on their cell phone when they began to cross a dangerously small gap.

RESULTS

The results demonstrate the detrimental influence of texting on pedestrians' gap selection, movement timing, and gaze behavior, and show the potential of warnings to improve decision making and safety. However, the results also reveal the limits of warning texting participants once they initiate a crossing and possible overreliance on technology that may lead to reduced situation awareness.

CONCLUSION

Mobile devices and short-range communication technologies offer enormous potential to assist pedestrians, but further study is needed to better understand how to provide useful information in a timely manner.

APPLICATION

The technology for communicating traffic information to pedestrians via mobile devices is on the horizon. Research on how such information influences all aspects of pedestrian behavior is critical to developing effective solutions.

Effects of mobile phone distraction on pedestrians' crossing behavior and visual attention allocation at a signalized intersection: An outdoor experimental study

With the rapid growth in mobile phone use worldwide, traffic safety experts have begun to consider the impact of mobile phone distractions on pedestrian crossing safety. This study sought to investigate how mobile phone distractions (music distraction, phone conversation distraction and text distraction) affect the behavior of pedestrians while they are crossing the street. An outdoor-environment experiment was conducted among 28 college student pedestrians. Two HD videos and an eye tracker were employed to record and analyze crossing behavior and visual attention allocation. The results of the research showed that the three mobile phone distractions cause different levels of impairment to pedestrians' crossing performance, with the greatest effect from text distraction, followed by phone conversation distraction and music distraction. Pedestrians distracted by music initiate crossing later, have increased pupil diameter, and reduce their scanning frequency, fixation points and fixation times toward traffic signal area priorities. In addition to the above effects, pedestrians distracted by phone conversation cross the street more slowly, direct fewer fixation points to the right traffic area, and spend less fixation time and lower average fixation duration on the left traffic area. Moreover, pedestrians distracted by texting look left and right less often and switch, distribute and maintain less visual attention on the traffic environment. These findings may inform researchers, policy makers, and pedestrians.

Local vs. national: Epidemiology of pedestrian injury in a mid-Atlantic city

OBJECTIVE

Understanding pedestrian injury trends at the local level is essential for program planning and allocation of funds for urban planning and improvement. Because we hypothesize that local injury trends differ from national trends in significant and meaningful ways, we investigated citywide pedestrian injury trends to assess injury risk among nationally identified risk groups, as well as identify risk groups and locations specific to Baltimore City.

METHODS

Pedestrian injury data, obtained from the Baltimore City Fire Department, were gathered through emergency medical services (EMS) records collected from January 1 to December 31, 2014. Locations of pedestrian injuries were geocoded and mapped. Pearson's chi-square test of independence was used to investigate differences in injury severity level across risk groups. Pedestrian injury rates by age group, gender, and race were compared to national rates.

RESULTS

A total of 699 pedestrians were involved in motor vehicle crashes in 2014-an average of 2 EMS transports each day. The distribution of injuries throughout the city did not coincide with population or income distributions, indicating that there was not a consistent correlation between areas of concentrated population or concentrated poverty and areas of concentrated pedestrian injury. Twenty percent (n = 138) of all injuries occurred among children age ≤14, and 22% (n = 73) of severe injuries occurred among young children. The rate of injury in this age group was 5 times the national rate (Incident Rate Ratio [IRR] = 4.81, 95% confidence interval [CI], [4.05, 5.71]). Injury rates for adults ≥65 were less than the national average.

CONCLUSIONS

As the urban landscape and associated pedestrian behavior transform, continued investigation of local pedestrian injury trends and evolving public health prevention strategies is necessary to ensure pedestrian safety.

"Pokémon Go!" May Promote Walking, Discourage Sedentary Behavior in College Students

OBJECTIVE

To assess self-reported walking and sedentary behavior in young adults before and after downloading "Pokémon Go!".

MATERIALS AND METHODS

In September 2016, a sample of 358 (19.8 ± 2.1 years old, n = 187 females) college students who had downloaded "Pokémon Go!" on their cellular telephones (i.e., cell phones) were surveyed for weekly walking and sedentary behavior via the International Physical Activity Questionnaire. A single interview was administered to participants who estimated their walking and sedentary behavior at three time points: the week immediately preceding their download of "Pokémon Go!" (Baseline), the first week after downloading the game (Time 1), and the week the survey was completed (Time 2). Differences in self-reported physical activity and sedentary behavior across the three time points and across the two genders were compared via analyses of variance.

RESULTS

There was a significant main effect of time (F ≥ 49.3, P ≤ 0.001) for walking and sedentary behavior. Participants reported greater (t ≥ 9.5, P < 0.001) daily walking during Time 1 (218.6 ± 156.3 minutes) and Time 2 (182.7 ± 172.1 minutes) versus the baseline (108.5 ± 110.8 minutes). Walking behavior was also significantly greater (t = 4.1, P < 0.001) at Time 1 versus Time 2. Participants reported greater (t ≥ 6.5, P < 0.001) daily sedentary behavior during baseline (346.6 ± 201.3 minutes) versus both Time 1 (261.7 ± 172.4 minutes) and Time 2 (284.3 ± 175.4 minutes). Sedentary behavior was also significantly greater (t = 2.6, P = 0.03) at Time 2 versus Time 1. There were no effects of gender (F ≤ 1.8, P ≥ 0.17).

CONCLUSION

Playing "Pokémon Go!" was associated with increased self-reported walking and decreased sedentary behavior. Such games hold promise as technology that may promote physical activity and discourage sedentary behavior.

Mind Your Step: the Effects of Mobile Phone Use on Gaze Behavior in Stair Climbing

Stair walking is a hazardous activity and a common cause of fatal and non-fatal falls. Previous studies have assessed the role of eye movements in stair walking by asking people to repeatedly go up and down stairs in quiet and controlled conditions, while the role of peripheral vision was examined by giving participants specific fixation instructions or working memory tasks. We here extend this research to stair walking in a natural environment with other people present on the stairs and a now common secondary task: using one’s mobile phone. Results show that using the mobile phone strongly draws one’s attention away from the stairs, but that the distribution of gaze locations away from the phone is little influenced by using one’s phone. Phone use also increased the time needed to walk the stairs, but handrail use remained low. These results indicate that limited foveal vision suffices for adequate stair walking in normal environments, but that mobile phone use has a strong influence on attention, which may pose problems when unexpected obstacles are encountered.

To Message or Browse? Exploring the Impact of Phone Use Patterns on Male Adolescents' Consumption of Palatable Snacks

Surveys of mobile phone usage suggest that adolescents habitually use their phones while eating. In this study, we explored whether the manner in which one uses a mobile phone – to engage in a social or non-social activity – can affect appetite regulation. Participants were fifty male adolescents randomly assigned to engage in one of the following phone-based activities: (1) sending and receiving messages (social activity), or (2) reading a neutral article (non-social activity). When given the opportunity to snack, participants in the messaging group consumed more snacks that those who read the article. Our findings correspond to a large literature emphasizing social influences on food intake, and suggest that phone use patterns may predispose an individual to overeating.

Reducing the impact of speed dispersion on subway corridor flow

The rapid increase in the volume of subway passengers in Beijing has necessitated higher requirements for the safety and efficiency of subway corridors. Speed dispersion is an important factor that affects safety and efficiency. This paper aims to analyze the management control methods for reducing pedestrian speed dispersion in subways. The characteristics of the speed dispersion of pedestrian flow were analyzed according to field videos. The control measurements which were conducted by placing traffic signs, yellow marking, and guardrail were proposed to alleviate speed dispersion. The results showed that the methods of placing traffic signs, yellow marking, and a guardrail improved safety and efficiency for all four volumes of pedestrian traffic flow, and the best-performing control measurement was guardrails. Furthermore, guardrails' optimal position and design measurements were explored. The research findings provide a rationale for subway managers in optimizing pedestrian traffic flow in subway corridors.

Examining how different measurement approaches impact safety outcomes in child pedestrian research: Implications for research and prevention

There has been a great deal of research aimed at understanding the causes of child pedestrian injury. Many different methods have been employed with the goal of designing simulations that produce rigorous assessment of children's behaviors without putting children at risk of actual pedestrian injury. Most research has assessed children's pre-crossing decision making and extrapolated crossing outcome measures from estimates of mean walking speed. This study explores the nature and extent of measurement bias that is introduced when average walking speed is used to produce estimates of outcomes versus measuring actual in-road behavior directly. Using a within-subjects design and a fully immersive virtual reality pedestrian simulator, both measures were taken. Comparisons based on regression models revealed the extent of differences in results produced by measurement bias. Results indicated that measurement bias is produced when average walking speed is used such that hits and high risk crossings are overestimated and missed opportunities are underestimated, resulting in an overall overestimate of children's risk for pedestrian injury. The discussion highlights how these two measurement approaches emphasize different underlying processes as determinants of child pedestrian injury risk.

Distracted Walking, Bicycling, and Driving: Systematic Review and Meta-Analysis of Mobile Technology and Youth Crash Risk

This article examined the impact of mobile technology on young pedestrians, bicyclists, and drivers. A systematic search yielded 41 articles meeting inclusion criteria: peer-reviewed, published before February 1, 2016, behavioral outcome related to pedestrian, bicycling, or driving in the presence of mobile technology use, youth sample. Eleven studies were meta-analyzed to evaluate increased risk for crash/near-crash while distracted. Risk of bias and quality of research were assessed. Across methodologies, developmental stages, and type of distracting task, mobile technology use impairs youth safety on the road. Quality of evidence was low (pedestrian) to moderate (driving). Findings are discussed from the perspective of cognitive and visual distractions. Policy and behavioral efforts should continue to reduce mobile technology use in transportation settings.

Augmented Reality Video Games: New Possibilities and Implications for Children and Adolescents

In recent years, the video game market has embraced augmented reality video games, a class of video games that is set to grow as gaming technologies develop. Given the widespread use of video games among children and adolescents, the health implications of augmented reality technology must be closely examined. Augmented reality technology shows a potential for the promotion of healthy behaviors and social interaction among children. However, the full immersion and physical movement required in augmented reality video games may also put users at risk for physical and mental harm. Our review article and commentary emphasizes both the benefits and dangers of augmented reality video games for children and adolescents.

Pedestrian Inattention Blindness While Playing Pokémon Go as an Emerging Health-Risk Behavior: A Case Report

BACKGROUND

Cases of trauma resulting from the use of mobile phones while driving motor vehicles have become quite common in recent years. Road injuries incurred by people playing video games on mobile phones (or other media devices) while walking have also become a cause for concern. Pokémon Go has been the world's most popular game since it was launched in July 2016, with more than 15 million players trying to catch all Pokémon available in the game; however, the case detailed here is the first reported accident in the medical literature caused by a pedestrian distracted by the game while crossing a street.

OBJECTIVE

We aim to provide additional information on the innovative nature of distractions that generate risks in road-users, and to explore the underreporting of pedestrian-motor vehicle collisions due to mobile device usage.

METHODS

We included in this case report a 25-year-old male who suddenly crossed a road while playing Pokémon Go and was hit by a van, reporting several injuries and being assisted by the Emergency Medical Service of our hospital (Padova, Italy). The patient's history, the circumstances in which the collision happened, imaging data, and clinical course information were recorded per our hospital's privacy policy.

RESULTS

The patient hit by the van was playing Pokémon Go on his mobile phone while crossing a street, despite red traffic lights, which he did not notice due to of the distraction induced by the game.

CONCLUSIONS

Mobile videogames that imply movement (ie, walking, running, cycling) to play are an effective way to improve physical activity practice, especially in adolescents and young adults. Nevertheless, cases like the one presented here point out that these games could pose a significant risk to users who play while walking, cycling, or driving in unsafe areas such as city streets, because players become distracted and may ignore surrounding hazards. Comprehensive, multilevel interventions are needed to reduce accidents caused by distraction, and to stress findings on the positive and negative effects of video games, which are becoming a source of public health concern. Health care providers should be aware of their chief role in these possible prevention strategies, based on their direct interactions with road incident victims.

Videogame-Related Illness and Injury: A Review of the Literature and Predictions for Pokémon GO!

OBJECTIVE

Reports of videogame-related illness and injury soon emerged in the literature with the inception of videogame systems and subsequent development of novel gaming platforms and technologies. In an effort to better detail the impacts of these phenomena and provide recommendations for injury prevention as it relates to Pokémon Go and the larger world of augmented reality games, we conducted an extensive systems-based review of past trends in videogame-related illness and injury from the literature.

MATERIALS AND METHODS

A literature review using PubMed, Medline, and PsycInfo databases with search terms "Pokémon GO," "videogame injuries," "augmented reality injuries," and "Nintendo Injury" was performed. The search was limited to the English language, and the Boolean were used to combine the search terms.

RESULTS

The literature search yielded 359 peer-reviewed articles, 44 of which met the study criteria and included in the review. Seventeen additional popular press reports detailing injuries related to Pokémon Go were also incorporated. Videogame-related injuries and illness include both physical trauma as well as psychological and behavioral disorder with unique patterns of injury and illness linked to specific gaming platforms.

CONCLUSIONS

As videogames become increasingly advanced and immersive, they expose players to unique and often more serious injury and illness. Augmented reality games, such as Pokémon GO, are the next step in the evolution of this trend and likely portend a future in which many pathologic processes may become increasingly common.

Virtual street-crossing performance in persons with multiple sclerosis: Feasibility and task performance characteristics

OBJECTIVES

Multiple sclerosis (MS) is a neurological disease that commonly results in physical and cognitive dysfunction. Accordingly, MS might impact the ability to safely cross the street. The purpose of this study was to examine the feasibility of a simulated street-crossing task in persons with MS and to determine differences in street-crossing performance between persons with MS and non-MS controls.

METHODS

26 participants with MS (median Expanded Disability Status Scale [EDSS] score = 3.5) and 19 controls completed 40 trials of a virtual street-crossing task. There were 2 crossing conditions (i.e., no distraction and phone conversation), and participants performed 20 trials per condition. Participants were instructed that the goal of the task was to cross the street successfully (i.e., without being hit be a vehicle). The primary outcome was task feasibility, assessed as completion and adverse events. Secondary outcomes were measures of street-crossing performance.

RESULTS

Overall, the simulated street-crossing task was feasible (i.e., 90% completion, no adverse events) in participants with MS. Participants with MS waited longer and were less attentive to traffic before entering the street compared with controls (all P < .05). Participants with MS also took longer to cross the street and were closer to oncoming vehicles when exiting the street compared to controls (all P < .05). When distracted, all participants took longer to initiate crossing, took longer to cross the street, and made more head turns while crossing (all P < .05). There were no significant group by condition interaction effects (all P > .05).

CONCLUSIONS

A virtual street-crossing task is feasible for studying street-crossing behavior in persons with mild MS and most individuals with moderate MS. Virtual street-crossing performance is impaired in persons with MS compared to controls; however, persons with MS do not appear to be more vulnerable to a distracting condition. The virtual reality environment presents a safe and useful setting for understanding pedestrian behavior in persons with MS.

Pedestrian self-reported use of smart phones: Positive attitudes and high exposure influence intentions to cross the road while distracted

Pedestrian crashes are an important issue globally as pedestrians are a highly vulnerable road user group, accounting for approximately 35% of road deaths worldwide each year. In highly motorised countries, pedestrian distraction by hand held technological devices appears to be an increasing factor in such crashes. An online survey (N=363) was conducted to 1) obtain prevalence information regarding the extent to which people cross the road while simultaneously using mobile phones for potentially distracting activities; 2) identify whether younger adult pedestrians are more exposed to/at risk of injury due to this cause than older adults; and 3) explore whether the Theory of Planned Behaviour (TPB) might provide insight into the factors influencing the target behaviours. Self-reported frequency of using a smart phone for three levels of distraction (visual and cognitive-texting/internet; cognitive only- voice calls; audio only-listening to music) while crossing the road was collected. Results indicated that about 20% of the sample had high exposure to smart phone use while crossing, especially 18-30year olds who were significantly more likely than other age groups to report frequent exposure. TPB constructs of Attitude, Subjective Norm, and Perceived Behavioural Control significantly predicted intentions to use a smart phone while crossing the road, accounting for 62% of variance in Intentions for the entire sample, and 54% of the variance for 18-30year olds. Additional variables of Mobile Phone Involvement and Group Norms provided an additional significant 6% of the variance explained for both groups. Attitude was by far the strongest predictor for both the whole sample and for 18-30year olds, accounting for 38% and 41% explained variance, respectively. This suggests that pedestrians with positive attitudes towards using their smart phones while crossing the road have stronger intentions to do so. Moreover, high exposure was associated with stronger intentions to use a smart phone while crossing, and the effect was large, suggesting high frequency mobile phone use may lead to riskier habits, such as failing to interrupt use while crossing the road. Interventions should target pedestrians under 30 years old and aim to strengthen negative attitudes towards using smart phones while crossing, or to challenge the perceived advantages or emphasise the disadvantages of using one's phone while crossing in order to reduce intentions to do so. Young people's perceptions that others in their social group approve of smart phone use while crossing could also be an important factor to address.

Virtual reality by mobile smartphone: improving child pedestrian safety

BACKGROUND

Pedestrian injuries are a leading cause of paediatric injury. Effective, practical and cost-efficient behavioural interventions to teach young children street crossing skills are needed. They must be empirically supported and theoretically based. Virtual reality (VR) offers promise to fill this need and teach child pedestrian safety skills for several reasons, including: (A) repeated unsupervised practice without risk of injury, (B) automated feedback on crossing success or failure, (C) tailoring to child skill levels: (D) appealing and fun training environment, and (E) most recently given technological advances, potential for broad dissemination using mobile smartphone technology.

OBJECTIVES AND METHODS

Extending previous work, we will evaluate delivery of an immersive pedestrian VR using mobile smartphones and the Google Cardboard platform, technology enabling standard smartphones to function as immersive VR delivery systems. We will overcome limitations of previous research suggesting children learnt some pedestrian skills after six VR training sessions but did not master adult-level pedestrian skills by implementing a randomised non-inferiority trial with two equal-sized groups of children ages 7-8 years (total N=498). All children will complete baseline, postintervention and 6-month follow-up assessments of pedestrian safety and up to 25 30-min pedestrian safety training trials until they reach adult levels of functioning. Half the children will be randomly assigned to train in Google Cardboard and the other half in a semi-immersive kiosk VR. Analysis of Covariance (ANCOVA) models will assess primary outcomes.

DISCUSSION

If results are as hypothesised, mobile smartphones offer substantial potential to overcome barriers of dissemination and implementation and deliver pedestrian safety training to children worldwide.

Cellular telephone use during free-living walking significantly reduces average walking speed

BACKGROUND

Cellular telephone (cell phone) use decreases walking speed in controlled laboratory experiments and there is an inverse relationship between free-living walking speed and heart failure risk. The purpose of this study was to examine the impact of cell phone use on walking speed in a free-living environment.

METHODS

Subjects (n = 1142) were randomly observed walking on a 50 m University campus walkway. The time it took each subject to walk 50 m was recorded and subjects were coded into categories: cell phone held to the ear (talking, n = 95), holding and looking at the cell phone (texting, n = 118), not visibly using the cell phone (no use, n = 929).

RESULTS

Subjects took significantly (p < 0.001) longer traversing the walkway when talking (39.3 s) and texting (37.9 s) versus no use (35.3 s).

CONCLUSION

As was the case with the previous laboratory experiments, cell phone use significantly reduces average speed during free-living walking.

The Effects of Cell Phone and Text Message Conversations on Simulated Street Crossing

OBJECTIVE

A fully immersive, high-fidelity street-crossing simulator was used to examine the effects of texting on pedestrian street-crossing performance.

BACKGROUND

Research suggests that street-crossing performance is impaired when pedestrians engage in cell phone conversations. Less is known about the impact of texting on street-crossing performance.

METHOD

Thirty-two young adults completed three distraction conditions in a simulated street-crossing task: no distraction, phone conversation, and texting. A hands-free headset and a mounted tablet were used to conduct the phone and texting conversations, respectively. Participants moved through the virtual environment via a manual treadmill, allowing them to select crossing gaps and change their gait.

RESULTS

During the phone conversation and texting conditions, participants had fewer successful crossings and took longer to initiate crossing. Furthermore, in the texting condition, smaller percentage of time with head orientation toward the tablet, fewer number of head orientations toward the tablet, and greater percentage of total characters typed before initiating crossing predicted greater crossing success.

CONCLUSION

Our results suggest that (a) texting is as unsafe as phone conversations for street-crossing performance and (b) when subjects completed most of the texting task before initiating crossing, they were more likely to make it safely across the street.

APPLICATION

Sending and receiving text messages negatively impact a range of real-world behaviors. These results may inform personal and policy decisions.

Distracted Driving in Teens With and Without Attention-Deficit/Hyperactivity Disorder

OBJECTIVE

This study is among the first to examine the effect of talking on a cell phone or text messaging while driving in teens with and without attention deficit/hyperactivity disorder (ADHD).

METHOD

Teens (average age 17years) with a diagnosis of ADHD (N=16) were matched with typically developing controls (N=18). All participants operated a driving simulator while (1) conversing on a cell phone, (2) text messaging, and (3) with no distraction during a baseline condition. Six indicators of driving performance were recorded: (a) time to complete the drive; (b) lane deviations; (c) variability in lane position (i.e., root mean square [RMS]); (d) reaction time; (e) motor vehicle collisions; and, (f) speed fluctuation.

RESULTS

Significantly greater variation in lane position occurred in the texting task compared to no task and the cell phone task. While texting, in particular, teens with ADHD took significantly less time to complete the scenario. No significant main effects of group were found.

CONCLUSIONS

Generally, those with ADHD did not differ in regard to driving performance, when compared to controls, with the exception of one outcome: time to complete scenario. These findings suggest that distracted driving impairs driving performance of teen drivers, regardless of ADHD status. Texting while driving had the greatest negative impact on driving performance, particularly with regard to variability in lane position (i.e., RMS). This study sheds light on key issues regarding injury prevention, with the intent of providing pediatric care providers with the knowledge to inform teen drivers of risks associated with distracted driving which will ultimately result in reduced rates of motor vehicle crashes and concomitant injuries.

The incidence of pedestrian distraction at urban intersections after implementation of a Streets Smarts campaign

BACKGROUND

Pedestrians distracted by digital devices or other activities are at a higher risk of injury as they cross streets. We sought to describe the incidence of pedestrians distracted by digital devices or other activities at two highly traveled urban intersections after the implementation of a pedestrian safety intervention at one of the intersections.

METHODS

This was an observational field study of two urban intersections. Two investigators were stationed at each of the four corners of the intersection. Each pair of observers included one "person counter" and one "behavior counter". The "person counter" tallied every individual who approached that corner from any of the three opposing corners. The "behavior counter" tallied every individual approaching from the three opposing corners who were exhibiting any of the following behaviors: 1) eating, 2) drinking, 3) wearing ear buds/headphones, 4) texting, 5) looking at mobile phone or reading something on mobile phone, or 6) talking on mobile phone. Every 15 min, each pair of observers rotated to the next corner of the same intersection, allowing each pair of observers to complete one 15-min observation at each of the four corners of the intersection. Intersection A had stencils at the curb cuts of each corner alerting pedestrians to put down a digital device while crossing the intersection while intersection B did not.

RESULTS

1362 pedestrians were observed; of those, 19 % were distracted by another activity at both intersections. Of the total, 9 % were using ear buds/headphones; 8 % were using a digital device (talking, texting, or looking down at it); and 2 % were eating or drinking. Inter-observer validity among observers (kappa) was 98 %. Of those that were distracted, 5 % were either using an assistive device (cane, walker, motorized scooter) or walking with a child (either on foot or in stroller). There were no differences in the proportion of pedestrians who were distracted at either intersection, except that more pedestrians were talking on a cell phone while crossing intersection B.

CONCLUSIONS

It is unclear to what degree a pedestrian safety messaging campaign is effective in decreasing distraction by digital devices. Further evaluation of the effect of posted warnings about pedestrian distraction on the safety of crossing behaviors is needed.

The impact of cell phone use on the intensity and liking of a bout of treadmill exercise

This study used a within-subjects design to assess the effect of three common cellular telephone (cell phone) functions (texting, talking, listening to music) on planned exercise. Forty-four young adults (n = 33 females, 21.8 ± 1.3 years) each participated in four, separate, 30-minute exercise conditions on a treadmill in a random order. During each condition, the treadmill speed display was covered and grade was fixed at zero. However, participants were able to alter treadmill speed as desired. Throughout the texting and talking conditions, research personnel used a pre-determined script to simulate cell phone conversations. During the music condition, participants used their cell phone to listen to music of their choice. Finally, participants completed a control condition with no cell phone access. For each condition, average treadmill speed, heart rate and liking (via visual analog scale) were assessed. Treadmill speed (3.4 ± 1.3 miles∙hour^-1), heart rate (122.3 ± 24.3 beats∙min^-1) and liking (7.5 ± 1.5 cm) in the music condition were significantly (p ≤ 0.014) greater than all other conditions. Treadmill speed in the control condition (3.1 ± 1.2 miles∙hour^-1) was significantly (p = 0.04) greater than both texting and talking (2.8 ± 1.1 miles∙hour^-1 each). Heart rate during the control condition (115.4 ± 22.8 beats∙min^-1) was significantly (p = 0.04) greater than texting (109.9 ± 16.4 beats∙min^-1) but not talking (112.6 ± 16.1 beats∙min^-1). Finally, liking during the talking condition (5.4 ± 2.2 cm) was greater (p = 0.05) than the control (4.3 ± 2.2 cm) but not the texting (5.1 ± 2.2 cm) conditions. In conclusion, using a cell phone for listening to music can increase the intensity (speed and heart rate) and liking of a bout of treadmill exercise. However, other common cell phone uses (texting and talking) can interfere with treadmill exercise and reduce intensity.

Urban crash-related child pedestrian injury incidence and characteristics associated with injury severity

OBJECTIVE

Describe age-based urban pedestrian versus auto crash characteristics and identify crash characteristics associated with injury severity.

MATERIALS AND METHODS

Secondary analysis of the 2004-2010 National Highway and Traffic Safety Administration database for Illinois. All persons in Chicago crashes with age data who were listed as pedestrians (n=7175 child age ≤19 yo, n=16,398 adult age ≥20 yo) were included. Incidence and crash characteristics were analyzed by age groups and year. Main outcome measures were incidence, crash setting, and injury severity. Multivariate logistic regression analysis was performed to estimate injury severity by crash characteristics.

RESULTS

Overall incidence was higher for child (146.6 per 100,000) versus adult (117.3 per 100,000) pedestrians but case fatality rate was lower (0.7% for children, 1.7% for adults). Child but not adult pedestrian injury incidence declined over time (trend test p<0.0001 for <5 yo, 5-9 yo, and 10-14 yo; p<0.05 for 15-19 yo, p=0.96 for ≥20 yo). Most crashes for both children and adults took place during optimal driving conditions. Injuries were more frequent during warmer months for younger age groups compared to older (χ(2)p<0.001). Midblock crashes increased as age decreased (p<0.0001 for trend). Most crashes occurred at sites with sub-optimal traffic controls but varied by age (p<0.0001 for trend). Crashes were more likely to be during daylight on dry roads in clear weather conditions for younger age groups compared to older (χ(2)p<0.001). Daylight was associated with less severe injury (child OR 0.93, 95% CI 0.87-0.98; adult OR 0.90, 95% CI 0.87-0.93).

CONCLUSION

The incidence of urban pedestrian crashes declined over time for child subgroups but not for adults. The setting of pedestrian crashes in Chicago today varies by age but is similar to that seen in other urban locales previously. Injuries for all age groups tend to be less severe during daylight conditions. Age-based prevention efforts may prove beneficial.

Epidemiology of pedestrian-MVCs by road type in Cluj, Romania

OBJECTIVE

Pedestrian-motor vehicle (PMV) crash rates in Romania are among the highest in all of Europe. The purpose of this study was to examine the characteristics of pedestrian-MVCs in Cluj County, Romania, on the two major types of roadways: national or local.

METHODS

Cluj County police crash report data from 2010 were used to identify pedestrian, driver and crash characteristics of pedestrian-MVCs. Crashes with available location data were geocoded and road type (national or local) for each crash was determined. Distributions of crash characteristics were examined by road type and multivariable logistic regression models were built to determine predictors of crash road type.

RESULTS

Crashes occurring on national roads involved more teenagers and adults, while those on local roads involved more young children (0-12) and older adults (65+) (p<0.01). Crashes on national roads were more likely to have marked pedestrian crossings and shoulders compared with local crashes. Pedestrian-MVCs that involved a moving violation by the motorist were more likely to occur on national roadways (adjusted OR=1.93, 95% CI 1.07 to 3.49).

CONCLUSIONS

Pedestrian-MVCs pose a considerable health burden in Romania. Results from this study suggest that factors leading to PMV crashes on national roads are more likely to involve driver-related causes compared with local roads. Intervention priorities to reduce pedestrian crashes on national roads should be directed towards driver behaviour on national roads. Further examination of driver and pedestrian behaviours related to crash risk on both national and local roads, such as distraction and speeding, is warranted.

Obstructive sleep apnea syndrome increases pedestrian injury risk in children

OBJECTIVES

To evaluate pedestrian behavior, including reaction time, impulsivity, risk-taking, attention, and decision-making, in children with obstructive sleep apnea syndrome (OSAS) compared with healthy controls.

STUDY DESIGN

Using a case control design, 8- to 16-year-olds (n = 60) with newly diagnosed and untreated OSAS engaged in a virtual reality pedestrian environment. Sixty-one healthy children matched using a yoke-control procedure by age, race, sex, and household income served as controls.

RESULTS

Children with OSAS were riskier pedestrians than healthy children of the same age, race, and sex. Children with OSAS waited less time to cross (P < .01). The groups did not differ in looking at oncoming traffic or taking longer to decide to cross.

CONCLUSIONS

Results suggest OSAS may have significant consequences on children's daytime functioning in a critical domain of personal safety, pedestrian skills. Children with OSAS appeared to have greater impulsivity when crossing streets. Results highlight the need for heightened awareness of the consequences of untreated sleep disorders and identify a possible target for pediatric injury prevention.