A matched case-control study evaluating the effectiveness of speed humps in reducing child pedestrian injuries

Major Traffic Safety Reform and Road Traffic Injuries Among Low-Income New York Residents, 2009-2021

Objectives. To evaluate the effects of a comprehensive traffic safety policy-New York City's (NYC's) 2014 Vision Zero-on the health of Medicaid enrollees. Methods. We conducted difference-in-differences analyses using individual-level New York Medicaid data to measure traffic injuries and expenditures from 2009 to 2021, comparing NYC to surrounding counties without traffic reforms (n = 65 585 568 person-years). Results. After Vision Zero, injury rates among NYC Medicaid enrollees diverged from those of surrounding counties, with a net impact of 77.5 fewer injuries per 100 000 person-years annually (95% confidence interval = -97.4, -57.6). We observed marked reductions in severe injuries (brain injury, hospitalizations) and savings of $90.8 million in Medicaid expenditures over the first 5 years. Effects were largest among Black residents. Impacts were reversed during the COVID-19 period. Conclusions. Vision Zero resulted in substantial protection for socioeconomically disadvantaged populations known to face heightened risk of injury, but the policy's effectiveness decreased during the pandemic period. Public Health Implications. Many cities have recently launched Vision Zero policies and others plan to do so. This research adds to the evidence on how and in what circumstances comprehensive traffic policies protect public health. (Am J Public Health. 2024;114(6):633-641. https://doi.org/10.2105/AJPH.2024.307617).

Traffic-Calming Measures and Road Traffic Collisions and Injuries: A Spatiotemporal Analysis

Traffic-calming measures (TCMs) are physical modifications of the road network aimed at making the roads safer. Although researchers have reported reductions in numbers of road crashes and injuries tied to the presence of TCMs, such studies have been criticized for their pre-/post- designs. In this study, we aimed to complement our knowledge of TCMs' effectiveness by assessing their impact using a longitudinal design. The implementation of 8 TCMs, including curb extensions and speed humps, was evaluated at the intersection and census tract levels in Montreal, Quebec, Canada, from 2012 to 2019. The primary outcome was fatal or serious collisions among all road users. Inference was performed using a Bayesian implementation of conditional Poisson regression in which random effects were used to account for the spatiotemporal variation in collisions. TCMs were generally implemented on local roads, although most collisions occurred on arterial roads. Overall, there was weak evidence that TCMs were associated with study outcomes. However, subgroup analyses of intersections on local roads suggested a reduction in collision rates due to TCMs (median incidence rate ratio, 0.31; 95% credible interval: 0.12, 0.86). To improve road safety, effective counterparts of TCMs on arterial roads must be identified and implemented.

Effectiveness of road safety interventions: An evidence and gap map

Background

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

Objectives

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

Search Methods

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

Selection Criteria

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

Data Collection and Analysis

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

Main Results

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

Authors' Conclusions

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

A matched case-control approach to identify the risk factors of fatal pedestrian crashes on a six-lane rural highway in India

Globally, the increase in pedestrian fatalities due to road traffic crashes (RTCs) on transport networks has been a major concern. In low- and middle-income countries (LMICs), pedestrians face a high risk due to RTCs on the rural highway network. The safety evaluation methods, such as observational before-after, empirical Bayes, full Bayes, and cross-sectional methods have been used to identify risk factors of RTCs. However, these methods are data-intensive and have associated limitations. Thus, this study employed a matched case-control method to identify the risk factors of fatal pedestrian crashes. This study utilized crash, traffic volume, speed, geometric, and roadside environment data of a 175 km six-lane rural highway in India. The identified major risk factors, such as clear zone width, the presence of habitation, service roads, and horizontal curve sections, increase the likelihood of a fatal pedestrian crash. This study provides specific insights for modifying the speed limit of highway sections passing through habitation. On such highway sections, designers should shift focus to pedestrian safety. It also suggests that the service road design needs to be reconsidered from a pedestrian safety viewpoint. The proposed method can be used in any other setting having similar traffic and socio-economic conditions.

Evaluation of a Road Safety Awareness Campaign Deployed along the Roadside in Saguenay (Québec, Canada)

For the past few years, police officers from the City of Saguenay have been installing a billboard combined with a damaged car along roadsides to make drivers aware of the road risks related to dangerous behaviors at the wheel. To assess the short-term effect of this device, evaluative research with a quasi-experimental design with pre-exposure, during, and post-exposure. The results show a significant decrease (p < 0.001) of 0.637 km/h for the first site (a 70 km/h zone) and 0.269 km/h for the second site (a 50 km/h zone) when the device is exposed. At the time of this last evaluation, a reduction of 1.255 km/h remained even after the advertising panel was removed. Although minimal, this speed reduction where the billboards are placed shows the police that this awareness-raising approach works since it reduces the speed of motorists at very low cost.

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

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

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.

Effects of speed humps on vehicle speed and pedestrian crashes in South Korea

INTRODUCTION

Speeding is a crucial risk factor for pedestrian safety because it shortens reaction time while increasing the impact force in collisions. Various types of traffic calming measures to prevent speeding have been devised. A speed hump-a raised bump installed in the pavement-has been widely used for this purpose.

METHOD

To evaluate the effectiveness of speed humps, the speed profiles of vehicles passing speed humps were analyzed along with pedestrian crash records near speed humps.

RESULTS

The speed profiles showed that vehicles gradually diminished their speeds starting 30 m ahead of speed humps and, immediately after passing the humps, accelerated to regain their original speeds within a distance of 30 m. This speed reduction effect is substantial on both local and major roads: 18.4% and 24.0% reduction in speeds, respectively. The analysis of pedestrian crash records revealed that, inside the zones of speed reduction effect near speed humps (i.e., ±30 m from speed humps), fewer pedestrian crashes per roadway distance occurred and pedestrian injuries were less severe, compared with events outside the effect zones. This safety improvement was greater on major roads than local roads. Practical Applications: This work finds that the speed reductions that occurred near speed humps were gradual and influential ±30 m from their locations, suggesting that the hump installations should be close enough to the pedestrian crossings. It is noteworthy that, albeit that speed humps are more prevalent on local roads, the benefits of speed reduction effects from speed humps were more pronounced on major roads than on local roads. Therefore, speed humps on major roads can be considered a more effective measure for pedestrian safety.

Effects Influencing Pedestrian–Vehicle Crash Frequency by Severity Level: A Case Study of Seoul Metropolitan City, South Korea

This study aimed to determine how built environments affect pedestrian–vehicle collisions. The study examined pedestrian–vehicular crashes that occurred between 2013 and 2015 in Seoul, Korea, by comparing and analyzing different effects of the built environment on pedestrian–vehicle crashes. Specifically, the study analyzed built environment attributes, land use environment, housing types, road environment, and traffic characteristics to determine how these factors affect the severity of pedestrian injury. The results of the statistical analysis appear to infer that the built environment attributes had dissimilar impacts on pedestrian collisions, depending on the injury severity. In general, both incapacitating and non-incapacitating injuries appear to be more likely to be caused by the built environment than fatal and possible injuries. These results highlight the need to consider injury severity when implementing more effective interventions and strategies for ensuring pedestrian safety. However, because of the small sample size, an expanded research project regarding this issue should be considered, as it would contribute to the development and implementation of effective policies and interventions for pedestrian safety in Korea. This study therefore offers practical information regarding the development of such an expanded study to inform future traffic safety policies in Seoul to establish a “safe walking city.”

Understanding complex traffic road scenes: The case of child-pedestrians' hazard perception

INTRODUCTION

Understanding the shortcomings of child-pedestrians in evaluating traffic situations may contribute to producing intervention techniques that may increase their awareness to potential hazards as well as inform and inspire designers of autonomous vehicle and infrastructure systems to deal with the complications of crossing pedestrians.

METHOD

The present work examined pedestrians' hazard-perception (HP) skills in complex traffic scenes. Two experiments explored how pedestrians' HP abilities vary with age and experience. In the first, adults and youngsters (7-13-year-olds) were presented with pairs of photographs displaying traffic situations and instructed to compare between the hazard levels of the two. Findings revealed a marked trend where experienced-adults tended to rate photographs depicting field of view partially obscured by parked vehicles as more hazardous. Moreover, adults tended to rate photographs depicting vehicles closer to the crossing site as more hazardous. Lastly, adults tended to rate photographs depicting complex configurations like traffic circles, as more hazardous than T-junctions.

RESULTS

Findings suggested that youngsters may be highly influenced by cueing. Next, pedestrians' HP was tested using a crossing decision task. Participants observed traffic scenes presented in a dynamic simulated environment of an urban road from a pedestrian's perspective and pressed a response button whenever they assumed it was safe to cross. Compared to experienced-adults and 7-8-year-olds, 9-13-year-olds presented a less decisive performance. Compared to previous findings regarding simpler road crossing configurations, most participants, regardless of age, related more to the approaching vehicles and presence of a pedestrian crossing while refraining from addressing the road configuration. Implications for road-safety are discussed.

The Effect of Brick and Granite Block Paving Materials on Traffic Speed

Slowing traffic speed in urban areas has been shown to reduce pedestrian injuries and fatalities due to automobile accidents. This research aims to measure how brick and granite block paving materials, which were widely used historically prior to the use of asphalt paving in many cities, may influence free flow traffic speed. Traffic speeds for 690 vehicles traversing street blocks paved with asphalt, granite block, and brick materials were measured using a radar gun on a sample of 18 matched pair (asphalt and historic paving material) street blocks in Philadelphia, Pennsylvania. Fixed effects linear regression was used to estimate the effect of paving material on vehicle speed after controlling for the street class (e.g., arterial versus local road) and the matched pair. Results indicate that brick reduced speeds by approximately 3 mph (~5 km/h) and granite block reduced speeds by approximately 7 mph (~11 km/h), as compared to asphalt paved city streets, which we attribute to drivers intentionally slowing due to road roughness. This research suggests that brick and granite block paving materials may be an effective traffic calming strategy, having implications for reducing negative health outcomes associated with pedestrian–automobile collisions.

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

Introduction

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

Method

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

Results

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

Conclusions

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

Evaluation of the effectiveness of traffic calming measures on vehicle speeds and pedestrian injury severity in Ghana

Objectives: Each year, pedestrian injuries constitute over 40% of all road casualty deaths and up to 60% of all urban road casualty deaths in Ghana. This is as a result of the overwhelming dependence on walking as a mode of transport in an environment where there are high vehicular speeds and inadequate pedestrian facilities. The objectives of this research were to establish the (1) impact of traffic calming measures on vehicle speeds and (2) association between traffic calming measures and pedestrian injury severity in built-up areas in Ghana. Method: Vehicle speeds were unobtrusively measured in 38 selected settlements, including 19 with traffic calming schemes and 19 without. The study design used in this research was a matched case-control. A regression analysis compared case and control casualties using a conditional logistic regression. Results: Generally, the mean vehicle speeds and the proportion of vehicles exceeding the 50 km/h speed limit were significantly lower in settlements that have traffic calming measures compared to towns without any traffic calming measures. Additionally, the proportion of motorists who exceeded the speed limit was 30% or less in settlements that have traffic calming devices and the proportion who exceeded the speed limit was 60% or more in towns without any traffic calming measures. The odds of pedestrian fatality was significantly higher in settlements that have no traffic calming devices compared to those that have (odds ratio [OR] = 1.98; 95% confidence interval, 1.09-4.43). The protective effects of a traffic calming scheme that has a speed table was notably higher than those where there were no speed tables. Conclusion: It was clearly evident that traffic calming devices reduce vehicular speeds and, thus, the incidence and severity of pedestrian injuries in built-up areas in Ghana. However, the fact that they are deployed on arterial roads is increasingly becoming a road safety concern. Given the emerging safety challenges associated with speed calming measures, we recommend that their use be restricted to residential streets but not on arterial roads. Long-term solutions for improving pedestrian safety proposed herein include bypassing settlements along the highways to reduce pedestrians' exposure to traffic collisions and adopting a modern way of enforcement such as evidence-based laser monitoring in conjunction with a punishment regime that utilizes the demerit points system.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

A fundamental experimental approach for optimal design of speed bumps

Speed bumps and humps are utilized as means of calming traffic and controlling vehicular speed. Needless to say, bumps and humps of large dimensions in length and width force drivers to significantly reduce their driving speeds so as to avoid significant vehicle vertical acceleration. It is thus that this experimental study was conducted with the aim of determining a speed bump design that performs optimally when leading drivers to reduce the speed of their vehicles to safe levels. The first step of the investigation starts off by considering the following question: "What is the optimal design of a speed bump that will - at the same time - reduce the velocity of an incoming vehicle significantly and to a speed that resulting vertical acceleration does not jeopardize road safety? The experiment has been designed to study the dependent variables and collect data in order to propose an optimal design for a speed bump. To achieve this, a scaled model of 1:6 to real life was created to simulate the interaction between a car wheel and a speed bump. During the course of the experiment, a wheel was accelerated down an inclined plane onto a horizontal plane of motion where it was allowed to collide with a speed bump. The speed of the wheel and the vertical acceleration at the speed bump were captured by means of a Vernier Motion Detector.

Child road traffic injury mortality in Victoria, Australia (0-14 years), the need for targeted action

INTRODUCTION

Extensive efforts to reduce unintentional injury were enacted in the last three decades of the 20th century. Examination of road traffic injury mortality indicates the extent of fatal, unintentional child injuries (0-14 years) future interventions must address.

AIMS

(1) describe in-depth child road traffic injury (RTI) deaths 2001-2012 in Victoria, Australia (2) identify the potential preventability of the RTI causes by currently available countermeasures and scope for enhanced implementation and novel solutions.

METHOD

Fatal Victorian child injury data were extracted from the National Coronial Information System (NCIS) for the 12 year period January 2001-December 2012. All on-road data was analysed. Data for passenger and pedestrian deaths was examined in depth. Associated factors were determined using univariate and pairwise analysis of factors. Published WHO key prevention strategies, and the recent literature were reviewed, focusing on the identified fatalities among children 0-14 years.

RESULTS

For 172 RTI deaths, head injury was the leading medical cause of death (68%). Significantly, the most vulnerable age group for both passengers and pedestrians was 0-4 years. Rural children were over-represented with children aged 0-4 years at greatest risk. Common factors for occupants were loss of control and veering to the incorrect side. For pedestrians the major factors related to rural residence and supervision.

DISCUSSION AND CONCLUSIONS

This study confirms that RTIs are complex and follow chains of events. Numerous promising interventions were identified. Wider implementation of these advanced engineering, education and enforcement strategies may further improve mortality rates in Victoria. Feasible solutions for aspects of the child pedestrian problem remain elusive. This study describes the RTI problem in greater depth than previous studies and reveals that some existing measures are not fully implemented. The need for targeted action in: 0-4 year olds; head injury; and rural regions of Victoria is highlighted. The need for a safe systems approach is paramount.

Cost-effectiveness of neighbourhood slow zones in New York City

BACKGROUND

Neighbourhood slow zones (NSZs) are areas that attempt to slow traffic via speed limits coupled with other measures (eg, speed humps). They appear to reduce traffic crashes and encourage active transportation. We evaluate the cost-effectiveness of NSZs in New York City (NYC), which implemented them in 2011.

METHODS

We examined the effectiveness of NSZs in NYC using data from the city's Department of Transportation in an interrupted time series analysis. We then conducted a cost-effectiveness analysis using a Markov model. One-way sensitivity analyses and Monte Carlo analyses were conducted to test error in the model.

RESULTS

After 2011, road casualties in NYC fell by 8.74% (95% CI 1.02% to 16.47%) in the NSZs but increased by 0.31% (95% CI -3.64% to 4.27%) in the control neighbourhoods. Because injury costs outweigh intervention costs, NSZs resulted in a net savings of US$15 (95% credible interval: US$2 to US$43) and a gain of 0.002 of a quality-adjusted life year (QALY, 95% credible interval: 0.001 to 0.006) over the lifetime of the average NSZ resident relative to no intervention. Based on the results of Monte Carlo analyses, there was a 97.7% chance that the NSZs fall under US$50 000 per QALY gained.

CONCLUSION

While additional causal models are needed, NSZs appeared to be an effective and cost-effective means of reducing road casualties. Our models also suggest that NSZs may save more money than they cost.

Vision zero: a toolkit for road safety in the modern era

Vision Zero (VZ) is a public program that aims to have zero fatalities or serious injuries from road traffic crashes. This article examines various major components of VZ: how VZ redefines road safety, how VZ principles and philosophies can be applied to modern car and road designs, and how VZ can be applied to traffic. Applications of these principles to real-world traffic infrastructure are explored in order to show policymakers the toolkits available to increase road safety while taking into consideration local contexts.

School environments and social risk factors for child pedestrian-motor vehicle collisions: A case-control study

BACKGROUND

Child pedestrian-motor vehicle collisions (PMVCs) have decreased in Canada in the past 20 years. Many believe this trend is explained by the rise in automobile use for all travel. Initiatives to increase walking to school need to consider PMVC risk. Potential risk factors related to walking to school, the built environment and social factors were examined for schools with historically high child PMVC rates.

METHODS

Child PMVCs (age 4-12 years) from 2000 to 2013 and built environment features were mapped within school attendance boundaries in the City of Toronto, Canada. Case and control schools were in the highest and lowest PMVC quartiles respectively. Observational counts of travel mode to school were conducted. Logistic regression evaluated walking to school, built environment and social risk factors for higher PMVC rates, stratified by geographic location (downtown vs. inner suburbs).

RESULTS

The mean PMVC rates were 18.8/10,000/year (cases) and 2.5/10,000/year (controls). One-way street density (OR=4.00), school crossing guard presence (OR=3.65) and higher social disadvantage (OR=1.37) were associated with higher PMVCs. Higher residential land use density had a protective effect (OR=0.56). More walking was not a risk factor. While several built environment risk factors were identified for the inner suburbs; only social disadvantage was a risk factor within older urban neighbourhoods.

CONCLUSIONS

Several modifiable environmental risk factors were identified for child PMVCs. More walking to school was not associated with increased PMVCs after controlling for the environment. School social disadvantage was associated with higher PMVCs with differences by geographic location. These results have important implications for the design of roadways around schools.

Use of Google Street View to Assess Environmental Contributions to Pedestrian Injury

OBJECTIVES

To demonstrate an information technology-based approach to assess characteristics of streets and intersections associated with injuries that is less costly and time-consuming than location-based studies of pedestrian injury.

METHODS

We used imagery captured by Google Street View from 2007 to 2011 to assess 9 characteristics of 532 intersections within New York City. We controlled for estimated pedestrian count and estimated the relation between intersections' characteristics and frequency of injurious collisions.

RESULTS

The count of pedestrian injuries at intersections was associated with the presence of marked crosswalks (80% increase; 95% confidence interval [CI] = 2%, 218%), pedestrian signals (156% increase; 95% CI = 69%, 259%), nearby billboards (42% increase; 95% CI = 7%, 90%), and bus stops (120% increase; 95% CI = 51%, 220%). Injury incidence per pedestrian was lower at intersections with higher estimated pedestrian volumes.

CONCLUSIONS

Consistent with in-person study observations, the information-technology approach found traffic islands, visual advertising, bus stops, and crosswalk infrastructures to be associated with elevated counts of pedestrian injury in New York City. Virtual site visits for pedestrian injury control studies are a viable and informative methodology.

Can child-pedestrians' hazard perception skills be enhanced?

OBJECTIVE

Traffic collisions yield a substantial rate of morbidity and injury among child-pedestrians. We explored the formation of an innovative hazard perception training intervention - Child-pedestrians Anticipate and Act Hazard Perception Training (CA(2)HPT). Training was based upon enhancing participants' ability to anticipate potential hazards by exposing them to an array of traffic scenes viewed from different angles.

METHOD

Twenty-four 7-9-year-olds have participated. Trainees underwent a 40-min intervention of observing typical residential traffic scenarios in a simulated dome projection environment while engaging in a hazard detection task. Trainees were encouraged to note differences between the scenarios presented to them from separate angles (a pedestrian's point-of-view and a higher perspective angle). Next, trainees and control group members were required to perform crossing decision tasks.

RESULTS

Trainees were found to be more aware of potential hazards related to restricted field of view relative to control.

CONCLUSIONS

Child pedestrians are responsive to training and actively detecting materialized hazards may enrich child-pedestrians' ability to cross roads.

Installation of speed humps and pedestrian-motor vehicle collisions in Toronto, Canada: a quasi-experimental study

Background

Evidence related to the effectiveness of speed humps on reducing pedestrian-motor vehicle collisions (PMVC) has been conflicting. The purpose of this study was to determine the association between speed hump installation and changes in PMVC rates in Toronto, Canada.

Methods

Speed humps were mapped along with police-reported pedestrian collisions from 2000–2011 and built environment roadway characteristics. A quasi-experimental study identified collision counts before and after speed hump installation, modeled using repeated measures Poisson regression adjusted for season and roadway characteristics. Stratified analyses were conducted by age group and injury severity.

Results

There were 27,827 PMVC, with 1344 collisions along 409 roadways with speed humps. PMVC incidence rates/meters of road/month decreased after installation of speed humps (IRR 0.78 95 % CI 0.66, 0.91). Winter, collector roads (versus local), pre-amalgamated city centre and increased land use mix were associated with more collisions. The association between speed humps and PMVC rates decreased more for children (IRR 0.57, 95 % CI 0.41, 0.79) than for adults (IRR 0.80, 95 % CI 0.68, 0.95).

Conclusions

Speed humps are an easily replicated method of traffic calming which have a significant protective effect on PMVC on the roadways where they are installed, particularly for children. There is a need for an area-wide analysis to determine the effects of the installation of speed humps to ensure that PMVC are not being displaced to surrounding roadways.

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.

Share of mass transit miles traveled and reduced motor vehicle fatalities in major cities of the United States

The USA leads the developed world in motor vehicle fatalities, presenting a critical public health threat. We examined whether an increasing share of mass transit use, relative to vehicle miles traveled on public roads, was associated with reduced motor vehicle fatalities. We used annual city-level data for the USA from 1982-2010 provided by the Fatality Accident Reporting System, the Texas A&M Transportation Institute, the Census Bureau, and the National Oceanic and Atmospheric Administration to estimate a structural equation model of the factors associated with mass transit miles and motor vehicle fatalities. The final analytic data included 2,900 observations from 100 cities over 29 years. After accounting for climate, year, and the economic costs of driving, an increasing share of mass transit miles traveled per capita was associated with reduced motor vehicle fatalities. The costs of congestion to the average commuter and gas prices were positively associated with increasing the share of mass transit miles traveled. The economic costs of driving increased over time, while both the fatality rate and the share of mass transit miles traveled decreased over time. Increasing the share of mass transit miles traveled may be associated with fewer motor vehicle miles traveled. Increasing mass transit uptake may be an effective public health intervention to reduce motor vehicle fatalities in cities.

Developing a Measure of Traffic Calming Associated with Elementary School Students' Active Transport

The objective of this study is to develop a measure of traffic calming with nationally available GIS data from NAVTEQ and to validate the traffic calming index with the percentage of children reported by school administrators as walking or biking to school, using data from a nationally representative sample of elementary schools in 2006-2010. Specific models, with and without correlated errors, examined associations of objective GIS measures of the built environment, nationally available from NAVTEQ, with the latent construct of traffic calming. The best fit model for the latent traffic calming construct was determined to be a five factor model including objective measures of intersection density, count of medians/dividers, count of low mobility streets, count of roundabouts, and count of on-street parking availability, with no correlated errors among items. This construct also proved to be a good fit for the full measurement model when the outcome measure of percentage of students walking or biking to school was added to the model. The traffic calming measure was strongly, significantly, and positively correlated with the percentage of students reported as walking or biking to school. Applicability of results to public health and transportation policies and practices are discussed.

The walking environment in Lima, Peru and pedestrian-motor vehicle collisions: an exploratory analysis

OBJECTIVE

Pedestrians comprise 78% of the road fatalities in Peru. The objective of this study was to explore the relationship between the walking environment and pedestrian-motor vehicle collisions.

METHODS

A matched case-control study was used to detect the odds of a pedestrian-motor vehicle collision at a pedestrian crossing location. Data were collected from 11 sampled police commissaries in Lima, Peru.

RESULTS

In a multivariable model adjusting for vehicle and pedestrian flow, pedestrian collisions were less likely in the presence of a curb and sidewalk on both roadway sides (odds ratio [OR] = 0.19, 95% confidence interval [CI], 0.11-0.33) or a pedestrian barricade (OR = 0.11, 95% CI, 0.01-0.81). There was a greater risk of collisions for each street vendor present (OR = 2.82, 95% CI, 1.59-5.00) or whether any parked vehicles (OR = 3.67, 95% CI, 1.18-11.4) were present.

CONCLUSIONS

Improving or addressing these potentially modifiable features of the walking environment could improve pedestrian safety in Lima and in similar urban settings in low- and middle-income countries.

The influence of bicycle oriented facilities on bicycle crashes within crash concentrated areas

OBJECTIVE

This study analyzes environmental features that influence bicycle crashes within crash concentrated areas. This study particularly provides a systemic approach to analyzing major bicycle oriented facilities contributing to bicycle crashes within crash concentrated areas.

METHODS

This study applies geographic information systems (GIS) to the identification of crash concentrated areas in Riverside County, California using five years of crash data as well as the development of environment feature data inventory. Based on the data inventory, a regression method was applied to discover whether there was a correlation between the presence of bicycle facilities and the occurrence of bicycle crashes.

RESULTS

This study identifies that longer distance between crosswalks and bus stops are positively associated with bicyclist crashes, while structured medians contribute to the reduction of bicycle crashes. This study also suggests that parking lot entrance ways and parking lots with no physical barrier from sidewalks cause bicycle crashes on sidewalks.

CONCLUSIONS

This study presents guidelines for local transportation planners to analyze the patterns of bicyclist crashes in order to improve roadway safety. This research also assists planners in effectively allocating scarce resources as they address issues of bicyclist safety.

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.

Association of street connectivity and road traffic speed with park usage and park-based physical activity

PURPOSE

The purpose of this study was to examine associations between street connectivity and road traffic speed and neighborhood residents' use of parks and park-based physical activity.

DESIGN

Cross-sectional.

SETTING

Kansas City, Missouri.

SUBJECTS

Participants were 893 adults from randomly selected households.

MEASURES

Both self-reported park use and park-based physical activity were dichotomized as some versus none. Intersection density was calculated around each participant, and network analysis was used to determine whether participants had to travel on or cross a road with traffic speed greater than 35 miles per hour (mph) to reach the closest park.

ANALYSIS

Multilevel logistic regression examined the association between intersection density and traffic speed wit park use and park-based physical activity.

RESULTS

Compared to those in the lowest intersection density quartile, participants in the third and fourth quartiles were more likely to use parks and to engage in physical activity in parks (odds ratio [OR] = 1.76-2.34; all p < .05). Likewise, compared to those who had a high-speed road on their way to the closest park, participants with slower traffic routes to parks were more likely to use the parks (OR = 1.47; 95% confidence interval [CI] = 1.05-1.92).

CONCLUSION

In addition to park proximity and the design of park features, ensuring direct and safe access to parks through street network design and traffic speed reduction strategies may be key to facilitating park-related physical activity.

Altering school attendance times to prevent child pedestrian injuries

OBJECTIVES

The purpose of this research was to determine whether modifying school start time schedules can be used to reduce children's exposure to traffic on their morning walks to school.

METHODS

We use models of pedestrian and motor vehicle commuting to estimate the frequency of encounters between child pedestrians and motor vehicles at intersections throughout the City of Hamilton, Ontario, Canada. We use a simple heuristic to identify the school-specific start times that would most reduce the local frequency of encounters between motor vehicles and pedestrians.

RESULTS

Our analysis suggests that it may be possible to achieve an almost 15 percent reduction in the total number of encounters between child pedestrians and motor vehicles during the morning commute by staggering school start times such that the periods of high pedestrian activity are temporally staggered from periods of high motor vehicle activity. Our analysis suggests that small changes in school start times could be sufficient to see noteworthy reductions in pedestrian exposure to traffic.

CONCLUSIONS

Changing school times may be an effective, inexpensive, and practical tool for reducing child pedestrian injuries in urban environments. Enhanced transportation models and community-based interventions are natural next steps for exploring the use of school-specific scheduling to reduce the risk of child pedestrian injury. Further research is required to validate our models before this analysis should be used by policy makers.

Explaining reduction of pedestrian-motor vehicle crashes in Arkhangelsk, Russia, in 2005-2010

Objective

To explain a reduction in pedestrian–motor vehicle crashes in Arkhangelsk, Russia, in 2005–2010.

Study design

Retrospective ecological study.

Methods

For 2005–2010, police data on pedestrian–motor vehicle crashes, traffic violations, and total motor vehicles (MVs) were combined with data on changes in national road traffic legislation and municipal road infrastructure. Negative binomial regression was used to investigate trends in monthly rates of pedestrian–motor vehicle crashes per total MVs and estimate changes in these rates per unit changes in the safety measures.

Results

During the 6 years, the police registered 2,565 pedestrian–motor vehicle crashes: 1,597 (62%) outside crosswalks, 766 (30%) on non-signalized crosswalks, and 202 (8%) on signalized crosswalks. Crash rates outside crosswalks and on signalized crosswalks decreased on average by 1.1% per month, whereas the crash rate on non-signalized crosswalks remained unchanged. Numbers of signalized and non-signalized crosswalks increased by 14 and 19%, respectively. Also, 10% of non-signalized crosswalks were combined with speed humps, and 4% with light-reflecting vertical signs. Pedestrian penalties for traffic violations increased 4-fold. Driver penalties for ignoring prohibiting signal and failure to give way to pedestrian on non-signalized crosswalk increased 7- and 8-fold, respectively. The rate of total registered drivers’ traffic violations per total MVs decreased on average by 0.3% per month. All studied infrastructure and legislative measures had inverse associations with the rate of crashes outside crosswalks. The rate of crashes on signalized crosswalks showed inverse associations with related monetary penalties.

Conclusions

The introduction of infrastructure and legislative measures is the most probable explanation of the reduction of pedestrian–motor vehicle crashes in Arkhangelsk. The overall reduction is due to decreases in rates of crashes outside crosswalks and on signalized crosswalks. No change was observed in the rate of crashes on non-signalized crosswalks.

Unintentional Injury Outcomes Secondary to Pedestrian Traffic Crashes: A Descriptive Analysis from a Major Medical Center

Introduction:

An environment in which traffic regulations are not strictly enforced often is characterized by carnage from motor vehicular crashes resulting in severe injuries with unacceptably high mortality. The descriptive demographics and injury characteristics of pedestrian road crash victims presenting to a tertiary medical center in southwestern Nigeria are presented in order to provide baseline epidemiology as a first step in determining areas of potential mitigation for care of unintentional injuries.

Methods:

Consecutive pedestrian road traffic crash patients treated in the Accident and Emergency Department of a tertiary hospital were prospective-ly reviewed from March 2007 to February 2008 to determine baseline demo-graphics and clinical outcomes.

Results:

A total of 184 patients with a mean value of the ages of 31.4 years were studied; 27% of the patients were <11 years of age. The male to female ratio was 1.6:1. Fifty-four percent of the victims were struck by automobiles and 29% were struck by motorcycles. Sixty-five percent were struck while crossing common thoroughfares. Head injury was sustained in 61% of patients. The mortality rate was 31.0% (n = 57). The clinical course leading to death showed 22.8% of the patients who died initially experienced hemorrhagic shock, 17.5% suffered a severe head injury, and 17.5% suffered aspiration. Autopsy confirmed brainstem herniation in 28.1% of the patients who died. The average interval between injury and death was 5.5 ±13.6 days (range: 0–77 days). In this setting, three out of every ten patients experienc-ing pedestrian vehicular trauma will die before leaving the hospital.The elder-ly are most at risk, with two-thirds of victims dying from injuries sustained.

Conclusions:

This raises serious questions about the prehospitaland hospi-tal-based emergency services for vehicular road crash victims in this environ-ment, and confirms the World Health Organization findings that Africa has the highest rate overall for unintentional injury deaths. A system-wide program must be put in place that addresses proven prevention measures across all sectors of the community.

The impact of pedestrian countdown signals on pedestrian-motor vehicle collisions: a quasi-experimental study

Objective

To determine whether pedestrian countdown signals (PCS) reduce pedestrian–motor vehicle collisions in the city of Toronto, Canada.

Methods

A quasi-experimental study design was used to evaluate the effect of PCS on the number of pedestrian–motor vehicle collisions in the city of Toronto, from January 2000 to December 2009. Each intersection acted as its own control. We compared the number of pedestrian–motor vehicle collisions per intersection-month before and after the intervention. Stratified models were used to evaluate effect modification by pedestrian age, injury severity and location (urban vs inner suburbs). Poisson regression analysis with repeated measures (generalised estimating equations) was used to estimate the RR and 95% CI.

Results

The analysis included 9262 pedestrian–motor vehicle collisions at 1965 intersections. The RR of collisions after PCS installation was 1.014 (95% CI 0.958 to 1.073), indicating no statistically significant effect of PCS on collisions. There was no evidence to suggest effect modification between PCS and collisions by age, injury severity or location.

Conclusion

The installation of PCS at 1965 signalised intersections in Toronto did not reduce the number of pedestrian–motor vehicle collisions at these intersections.

School administrators' perceptions of factors that influence children's active travel to school

BACKGROUND

Increasing children's active travel to school may be 1 strategy for addressing the growing prevalence of obesity among school age children. Using the School Travel Survey, we examined South Carolina school district leaders' perceptions of factors that influence elementary and middle school students walking to school.

METHODS

Frequency distributions and chi-square tests were used to analyze the survey responses; open-ended questions were reviewed qualitatively for recurring topics and themes.

RESULTS

School and district leaders (N = 314) most often reported street crossing safety (54.0%) and number of sidewalks (54.0%) as priority factors that should be addressed to increase students' active travel to school, followed by distance to school (46.0%), traffic volume (42.4%), parental attitudes (27.0%), traffic speed (26.7%), neighborhood condition (24.4%), and student attitudes (10.0%). Several respondents expressed concerns about liability issues related to students' active travel to school while others reported that schools are not responsible for students' safety once students leave school grounds. Independent of their comments about liability, respondents were concerned about the safety of students while walking to school.

CONCLUSIONS

Those promoting active travel to school may benefit from addressing those factors perceived as most important by school and district leaders, including street crossing safety, number of sidewalks, and by educating school and district leaders about liability and safety issues related to students walking to school.

Roadway characteristics and pediatric pedestrian injury

Changing the built environment is a sound, but often underutilized approach to injury control. The authors reviewed the literature and conducted a meta-analysis to synthesize the evidence on the association of roadway characteristics with risk of pediatric pedestrian injury. To synthesize the data, they converted results to odds ratios based on direct results or abstracted outcomes and used Bayesian meta-analytic approaches by modeling outcomes as the logit of a normally distributed set of outcomes with vague prior distributions for the central measure of effect and its variance. On the basis of 10 studies of roadway features restricted exclusively to pediatric populations, the synthesized effect estimate for the association of roadway characteristics with pedestrian injury risk was 2.5 (95% credible interval: 1.8, 3.2). The probability of a new study showing an association between the built roadway and pediatric pedestrian injury was nearly 100%. The authors concluded that the built environment is directly related to the risk of pedestrian injury. This review and meta-analysis suggests that even modest interventions to the built roadway environment may result in meaningful reductions in the risk of pediatric pedestrian injury.

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

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

20 Years of Research on Socioeconomic Inequality and Children's-Unintentional Injuries Understanding the Cause-Specific Evidence at Hand

Injuries are one of the major causes of both death and social inequalities in health in children. This paper reviews and reflects on two decades of empirical studies (1990 to 2009) published in the peer-reviewed medical and public health literature on socioeconomic disparities as regards the five main causes of childhood unintentional injuries (i.e., traffic, drowning, poisoning, burns, falls). Studies have been conducted at both area and individual levels, the bulk of which deal with road traffic, burn, and fall injuries. As a whole and for each injury cause separately, their results support the notion that low socioeconomic status is greatly detrimental to child safety but not in all instances and settings. In light of variations between causes and, within causes, between settings and countries, it is emphasized that the prevention of inequities in child safety requires not only that proximal risk factors of injuries be tackled but also remote and fundamental ones inherent to poverty.

Are safety-related features of the road environment associated with smaller declines in physical activity among youth?

This study examined how objective measures of the local road environment related to safety were associated with change in physical activity (including active transport) among youth. Few longitudinal studies have examined the impact of the road environment on physical activity among children/adolescents in their neighborhoods. Participants were children aged 8-9 years (n = 170) and adolescents aged 13-15 years (n = 276) in 2004. Data were collected in 2004 and 2006 during follow-up of participants recruited initially in 2001 from 19 primary schools in Melbourne, Australia. Walking/cycling to local destinations was parent-reported for children and self-reported by adolescents. Moderate-to-vigorous physical activity (MVPA) during nonschool hours was recorded using accelerometers. Road environment features in each participant's neighborhood (area within 800 m radius of their home) were measured objectively using a Geographical Information System. Linear regression analyses examined associations between road features and changes in active transport (AT) and MVPA over 2 years. Children's AT increased but MVPA levels decreased in both age groups; on average, younger girls recorded the greatest declines. The number of traffic/pedestrian lights was associated with DeltaAT among younger girls (B=0.45, p=0.004). The total length of walking tracks (in meters) was associated with AT among younger girls (B = 0.0016, p = 0.015) and adolescent girls (B = 0.0016, p = 0.002). For adolescent boys, intersection density was associated with AT (B = 0.03, p = 0.030). Slow points were associated with MVPA among younger boys before school (B = 1.55, p = 0.021), while speed humps were associated with MVPA among adolescent boys after school (B = 0.23, p = 0.015). There were many associations for adolescent girls: for example, the total length of local roads (B = 0.49, p = 0.005), intersection density (B = 0.05, p = 0.036), and number of speed humps (B = 0.33, p = 0.020) were associated with MVPA during nonschool hours. Safety-related aspects of the built environment are conducive to physical activity among youth and may help stem age-related declines in physical activity. Passive road safety interventions may promote AT and physical activity among less active girls, in particular.

The built environment: designing communities to promote physical activity in children

An estimated 32% of American children are overweight, and physical inactivity contributes to this high prevalence of overweight. This policy statement highlights how the built environment of a community affects children's opportunities for physical activity. Neighborhoods and communities can provide opportunities for recreational physical activity with parks and open spaces, and policies must support this capacity. Children can engage in physical activity as a part of their daily lives, such as on their travel to school. Factors such as school location have played a significant role in the decreased rates of walking to school, and changes in policy may help to increase the number of children who are able to walk to school. Environment modification that addresses risks associated with automobile traffic is likely to be conducive to more walking and biking among children. Actions that reduce parental perception and fear of crime may promote outdoor physical activity. Policies that promote more active lifestyles among children and adolescents will enable them to achieve the recommended 60 minutes of daily physical activity. By working with community partners, pediatricians can participate in establishing communities designed for activity and health.

Advances in the prevention of children's injuries: an examination of four common outdoor activities

PURPOSE OF REVIEW

Injuries remain the leading cause of death for children. Experts in paediatrics and child health have a current interest in promoting children's healthy active living. This review highlights findings from recent literature regarding the prevention of injuries from four common outdoor activities: bicycling, snowboarding and skiing, walking and playground activity.

RECENT FINDINGS

There is sound evidence for the effectiveness of bicycle helmets, the promotion of bicycle helmets at a community level and through physician counselling, and legislation; for the effectiveness of helmets for skiing and snowboarding; for the effectiveness of implementing playground safety standards; and for the effectiveness of modifications to the pedestrian physical environment.

SUMMARY

The science of injury prevention has advanced considerably. The highest level of evidence, including systematic reviews, is now available regarding the effectiveness of protective measures, engineering approaches to the environment and legislation. Healthcare providers caring for children play a leading role in injury prevention through child and family counselling, advocacy and research.

Validation of virtual reality as a tool to understand and prevent child pedestrian injury

In recent years, virtual reality has emerged as an innovative tool for health-related education and training. Among the many benefits of virtual reality is the opportunity for novice users to engage unsupervised in a safe environment when the real environment might be dangerous. Virtual environments are only useful for health-related research, however, if behavior in the virtual world validly matches behavior in the real world. This study was designed to test the validity of an immersive, interactive virtual pedestrian environment. A sample of 102 children and 74 adults was recruited to complete simulated road-crossings in both the virtual environment and the identical real environment. In both the child and adult samples, construct validity was demonstrated via significant correlations between behavior in the virtual and real worlds. Results also indicate construct validity through developmental differences in behavior; convergent validity by showing correlations between parent-reported child temperament and behavior in the virtual world; internal reliability of various measures of pedestrian safety in the virtual world; and face validity, as measured by users' self-reported perception of realism in the virtual world. We discuss issues of generalizability to other virtual environments, and the implications for application of virtual reality to understanding and preventing pediatric pedestrian injuries.

Neighborhood road environments and physical activity among youth: the CLAN study

We examined associations between objective measures of the local road environment and physical activity (including active transport) among youth. There is little empirical evidence of the impact of the road environment on physical activity among children/adolescents in their neighborhoods. Most recent studies have examined perceptions rather than objective measures of the road environment. This was a cross-sectional study of children aged 8-9 years (n = 188) and adolescents aged 13-15 years (n = 346) who were participants in the 3-year follow-up of the Children Living in Active Neighborhoods (CLAN) longitudinal study in Melbourne, Australia. At baseline (2001), they were recruited from 19 state primary schools in areas of varying socioeconomic status across Melbourne. Habitual walking/cycling to local destinations was parent-reported for children and self-reported for adolescents, while moderate-to-vigorous physical activity (MVPA) outside school hours was recorded using accelerometers. Road environment features in each participant's neighborhood (area of radius 800 m around the home) were measured objectively using a geographical information system. Regression analyses found no associations between road environment variables and children's likelihood of making at least seven walking/cycling trips per week to neighborhood destinations. Adolescent girls residing in neighborhoods with two to three traffic/pedestrian lights were more likely to make seven or more walking/cycling trips per week as those whose neighborhoods had fewer traffic lights (OR: 2.7; 95% CI: 1.2-6.2). For adolescent boys, residing on a cul-de-sac, compared with a through road, was associated with increases in MVPA of 9 min after school, 5 min in the evenings, and 22 min on weekend days. Speed humps were positively associated with adolescent boys' MVPA during evenings. The road environment influences physical activity among youth in different ways, according to age group, sex and type of physical activity.