Preventing child pedestrian injury: pedestrian education or traffic calming?

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.

Challenges related to pedestrian safety: a qualitative study identifying Iranian residents' perspectives

The pedestrians are among the most vulnerable group. This study was conducted to explain the challenges associated with pedestrian safety by taking into account the perspectives of Iranian residents in Tabriz. In this qualitative study, applying purposeful sampling approach, we recruited 49 residents to participate in structured qualitative interviews. To collect data, 3 Focus Group Discussions (FGDs) with 28 participants, and 21 individual interviews were conducted. Data analysis was performed applying conventional content analysis. MAXQDA10 was applied for the purpose of data management. After data analysis, six themes emerged including: (a) Pedestrians' own obstacles and challenges, (b) Driver' related obstacles and challenges, (c) Penal system related obstacles and challenges, (d) Advocacy-related obstacles and challenges, (e) Infrastructural obstacles and challenges, and (f) Management obstacles and challenges. Pedestrian safety was identified as a major but extremely intricate urban traffic and transportation issue. To promote pedestrian safety, it is essential for the municipal agencies to focus on the public's convenience through providing need-based infrastructures especially suiting to the elderlies. The agencies, here, must also introduce pedestrian penal system, penalty for using phone while driving, or superior road crossing mechanisms such as those discussed inside. The agencies should also focus on gross political commitment, and a broad strategy involving education, engineering and enforcement, institutional co-ordination within and between different levels of government and with private actors.

Data-Driven Opportunity to Reduce Elderly Pedestrian Trauma

Elderly patients are at high risk for mortality after injury, and prevention is imperative. Several studies have captured the value of traffic calming or environmental modifications; however, limited data support its use during focused times of the day to reduce pedestrian trauma. This study's aim was to identify when the elderly are more likely to be injured from pedestrian trauma. The Los Angeles County Trauma and Emergency Medicine Information System database was reviewed for all adult pedestrians who were struck by vehicles from 2000 to 2015. Elderly (≥65 years) patients were compared with nonelderly (range, 18–64 years) patients with respect to the time of admission and mortality. The proportion of elderly pedestrian injuries peaked between 9 and 10 am (23%). Compared with their nonelderly counterparts, the elderly were more likely to have a Glasgow Coma Scale ≤8 (11% vs 7%, P < 0.01), be hypotensive (6% vs 3%, P < 0.01), and have a higher Injury Severity Score (median 9 vs 5, P < 0.01). Mortality was significantly higher in the elderly (14% vs 4%, P < 0.01). Elderly pedestrians had an almost 5-fold higher adjusted odds ratio for death: 4.72 ( P < 0.01). Preventative strategies with lower speed limits or high surveillance during these hours in highly populated areas may result in a decreased incidence of these injuries.

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.

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.

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

Geographic studies of the incidence and prevalence of child pedestrian injury collisions in different community environments have been primarily descriptive and idiosyncratic, reflecting one or another likely determinant of the places where these injuries occur. The current study maintains that multiple determinants of child pedestrian injury collisions must be considered in evaluating the unique contributions of any one community feature to injury rates. These features include local characteristics of populations, such as rates of unemployment, and places, such as locations of schools. Schools are one stable geographic feature associated with regular, often concentrated periods of complex and congested traffic patterns. The objective of the present study was to examine annual rates of child pedestrian injury in four California communities with a focus on the unique contribution of schools to injury risk. We predicted that annual numbers of child pedestrian injury collisions (both in-school and summer combined) would be greater in communities with higher youth population densities, more unemployment, fewer high-income households, and higher traffic flow. It was hypothesized that youth population density and its interaction with the number of schools in a given area would be related to greater rates of child pedestrian collisions during in-school months. An ecological approach was taken that divided the four communities into 102 geographic units with an average of 6321 people residing in each unit. Archival data on traffic flow, number of child pedestrian injury collisions and locations of schools were obtained from state agencies. Individual-level data were obtained from a general population survey conducted in the communities. The results showed that annual numbers of injuries were greater in areas with higher youth population densities, more unemployment, fewer high-income households, and greater traffic flow. Annual numbers of injuries during in-school months were greater in areas containing middle schools and greater population densities of youth.

Strengthening the prevention and care of injuries worldwide

The global burden of injuries is enormous, but has often been overlooked in attempts to improve health. We review measures that would strengthen existing efforts to prevent and treat injuries worldwide. Scientifically-based efforts to understand risk factors for the occurrence of injury are needed and they must be translated into prevention programmes that are well designed and assessed. Areas for potential intervention include environmental modification, improved engineering features of motor vehicle and other products, and promotion of safe behaviours through social marketing, legislation, and law enforcement. Treatment efforts need to better define the most high-yield services and to promote these in the form of essential health services. To achieve these changes, there is a need to strengthen the capacity of national institutions to do research on injury control; to design and implement countermeasures that address injury risk factors and deficiencies in injury treatment; and to assess the effectiveness of such countermeasures. Although much work remains to be done in high-income countries, even greater attention is needed in less-developed countries, where injury rates are higher, few injury control activities have been undertaken, and where most of the world's population lives. In almost all areas, injury rates are especially high in the most vulnerable sections of the community, including those of low socioeconomic status. Injury control activities should, therefore, be undertaken in a context of attention to human rights and other broad social issues.

How willing are parents to improve pedestrian safety in their community?

STUDY OBJECTIVE

To determine how likely parents would be to contribute to strategies to reduce pedestrian injury risks and how much they valued such interventions.

DESIGN

A single referendum willingness to pay survey. Each parent was randomised to respond to one of five requested contributions towards each of the following activities: constructing speed bumps, volunteering as a crossing guard, attending a neighbourhood meeting, or attending a safety workshop.

SETTING

Community survey.

PARTICIPANTS

A sample of 723 Baltimore parents from four neighbourhoods stratified by income and child pedestrian injury risk. Eligible parents had a child enrolled in one of four elementary schools in Baltimore City in May 2001.

MAIN RESULTS

The more parents were asked to contribute, the less likely they were to do so. Parents were more likely to contribute in neighbourhoods with higher ratings of solidarity. The median willingness to pay money for speed bumps was conservatively estimated at $6.43. The median willingness to contribute time was 2.5 hours for attending workshops, 2.8 hours in community discussion groups, and 30 hours as a volunteer crossing guard.

CONCLUSIONS

Parents place a high value on physical and social interventions to improve child pedestrian safety.

Discrepancy between actual and estimated speeds of drivers in the presence of child pedestrians

OBJECTIVES

First, to measure the speeds of vehicles with and without children on the footpath, and second to compare these with drivers' estimates of how fast they would go in these conditions.

DESIGN

The speeds of vehicles in three conditions: control (no children present), children playing with a ball on the footpath, and children waiting to cross the road, were measured using speed tubes during two 55 minute sessions. Drivers' estimates of their speeds were measured with a questionnaire.

SETTING

Speeds were measured on a main road in Auckland, New Zealand. The questionnaire was conducted at another time with drivers stopping for petrol approximately 500 metres from the measurement site.

SUBJECTS

A total of 1446 speed measurements were taken and 93 drivers' questionnaire responses were analysed.

RESULTS

The mean free speed of vehicles in the control condition was 55.60 kph, with drivers' estimates being 56.37 kph. When children were playing with a ball the measured speed was 54.29 kph and the estimated speed 39.27 kph. When children were waiting to cross the measured speed was 52.78 kph, estimated speed 34.02 kph. Analyses indicated that there were significant differences between measured and estimated speeds.

CONCLUSIONS

New Zealand drivers make inadequate speed adjustments in the presence of children, despite probably believing they do so. Establishing specific rules about appropriate speeds around children and highlighting to drivers the discrepancy between their attitudes and behaviour are two intervention strategies suggested.

Mobilizing for pedestrian safety: an experiment in community action

In contrast to the steady reduction in mortality and morbidity from collisions involving motor vehicle occupants, relatively little progress has been made in controlling motor vehicle/pedestrian collisions. Engineering modifications are the most effective means of reducing such collisions, but mainly because of their cost, and public apathy about pedestrian safety, are too rarely employed. A modest experiment in community action was undertaken by attempting to induce the authorities of 10 small cities to apply for state funds to create a single model pedestrian refuge in their respective communities. Our hope was that this model would later lead to more widespread improvements. The key elements of the campaign were organizing local pedestrian safety task forces, compiling local pedestrian injury statistics, and publicizing the stories of pedestrian injury victims. At the conclusion of the planning process, all 10 target communities submitted grant applications and all 10 received full grant funding. Five projects were completed as planned, two are under construction, and the plans for three were abandoned. Pedestrian safety is not an issue that captures public attention. To make progress, goals must be modest, and a dedicated constituency must be developed. "Victim advocacy" is a vital part of this process. Progress in injury control requires concerted community action.

Safety education of pedestrians for injury prevention

BACKGROUND

Each year about one million people die and about 10 million are seriously injured on the world's roads. Educational measures to teach pedestrians how to cope with the traffic environment are considered to be an essential component of any prevention strategy, and pedestrian education has been recommended in many countries. However, as resources available for road safety are limited, a key question concerns the relative effectiveness of different prevention strategies.

OBJECTIVES

To quantify the effectiveness of pedestrian safety education programmes in preventing pedestrian-motor vehicle collisions.

SEARCH STRATEGY

We searched the Injuries Group specialised register, Cochrane Controlled Trials Register, TRANSPORT, MEDLINE, EMBASE, ERIC, PSYCHLIT, SPECTR, and the WHO database on the Internet. We checked reference lists of relevant reviews and papers and contacted experts in the field. Most database searching was conducted in 1999.

SELECTION CRITERIA

Randomised controlled trials of safety education programmes for pedestrians of all ages.

DATA COLLECTION AND ANALYSIS

One reviewer screened records. Two reviewers independently extracted data and assessed methodological quality of trials. Because of differences in the types of interventions and outcome measures used in the trials, meta-analyses were not carried out.

MAIN RESULTS

We found 15 randomised-controlled trials of pedestrian safety education programmes, conducted between 1976 and 1997. Methodological quality of the included trials was generally poor. Allocation concealment was adequate in three trials, outcome assessment was blinded in eight, and in most of the studies large numbers of participants were lost to follow-up. Study participants were children in 14 studies and institutionalised adults in one. Eight studies involved the direct education of participants, seven used parents as educators. No trials were conducted in a developing country and there were none of pedestrian safety training in the elderly. None of the included trials assessed the effect of pedestrian safety education on the occurrence of pedestrian injury but six trials assessed the effect on observed behaviour. Some of these trials showed evidence of behavioural change following pedestrian safety education but it is difficult to predict what effect this might have on pedestrian injury risk.

REVIEWER'S CONCLUSIONS

Pedestrian safety education can result in improvement in children's knowledge and can change observed road crossing behaviour but whether this reduces the risk of pedestrian motor vehicle collision and injury occurrence is unknown. There is evidence that changes in safety knowledge and observed behaviour decline with time suggesting that safety education must be repeated at regular intervals.

Epidemiology and prevention of traffic injuries to urban children and adolescents

OBJECTIVES

To describe the incidence of severe traffic injuries before and after implementation of a comprehensive, hospital-initiated injury prevention program aimed at the prevention of traffic injuries to school-aged children in an urban community.

MATERIALS AND METHODS

Hospital discharge and death certificate data on severe pediatric injuries (ie, injuries resulting in hospital admission and/or death to persons age <17 years) in northern Manhattan over a 13-year period (1983-1995) were linked to census counts to compute incidence. Rate ratios with 95% CIs, both unadjusted and adjusted for annual trends, were calculated to test for a change in injury incidence after implementation of the Harlem Hospital Injury Prevention Program. This program was initiated in the fall of 1988 and continued throughout the study period. It included 1) school and community based traffic safety education implemented in classroom settings in a simulated traffic environment, Safety City, and via theatrical performances in community settings; 2) construction of new playgrounds as well as improvement of existing playgrounds and parks to provide expanded off-street play areas for children; 3) bicycle safety clinics and helmet distribution; and 4) a range of supervised recreational and artistic activities for children in the community.

PRIMARY RESULTS

Traffic injuries were a leading cause of severe childhood injury in this population, accounting for nearly 16% of the injuries, second only to falls (24%). During the preintervention period (1983-1988), severe traffic injuries occurred at a rate of 147.2/100 000 children <17 years per year. Slightly <2% of these injuries were fatal. Pedestrian injuries accounted for two thirds of all severe traffic injuries in the population. Among school-aged children, average annual rates (per 100 000) of severe injuries before the intervention were 127.2 for pedestrian, 37.4 for bicyclist, and 25.5 for motor vehicle occupant injuries. Peak incidence of pedestrian and bicyclist injuries occurred during the summer months and afternoon hours, whereas motor vehicle occupant injuries showed little seasonal variation and were more common during evening and night-time hours. Age-specific rates showed peak incidence of pedestrian injuries among 6- to 10-year-old children, of bicyclist injuries among 9- to 15-year-old children, and of motor vehicle occupant injuries among adolescents between the ages of 12 and 16 years. The peak age for all traffic injuries combined was 15 years, an age at which nearly 3 of every 1000 children each year in this population sustained a severe traffic injury. Among children hospitalized for traffic injuries during the preintervention period, 6.3% sustained major head trauma (including concussion with loss of consciousness for >/=1 hour, cerebral laceration and/or cerebral hemorrhage), and 36.9% sustained minor head trauma (skull fracture and/or concussion with no loss of consciousness >/=1 hour and no major head injury). The percentage of injured children with major and minor head trauma was higher among those injured in traffic than among those injured by all other means (43.2% vs 14.2%, respectively; chi2 = 336; degrees of freedom = 1). The percentages of children sustaining head trauma were 45.4% of those who were injured as pedestrians, 40.2% of those who were injured as bicyclists, and 38.9% of those who were injured as motor vehicle occupants. During the intervention period, the average incidence of traffic injuries among school aged children declined by 36% relative to the preintervention period (rate ratio:.64; 95% CI:.58,.72). After adjusting for annual trends in incidence, pedestrian injuries declined during the intervention period among school aged children by 45% (adjusted rate ratio:.55; 95% CI:.38,.79). No comparable reduction occurred in nontargeted injuries among school-aged children (adjusted rate ratio:.89; 95% CI:.72, 1.09) or in traffic injuries among younger children who

Measuring community/environmental interventions: the Child Pedestrian Injury Prevention Project

OBJECTIVES

To assess the effectiveness of community/environmental interventions undertaken as part of the Child Pedestrian Injury Prevention Project (CPIPP).

SETTING

Three communities (local government areas) in the Perth metropolitan area, Western Australia.

METHODS

A quasiexperimental community intervention trial was undertaken over three years (1995-97). Three communities were assigned to either: a community/environmental road safety intervention and a school based road/pedestrian safety education program (intervention group 1); a school based road/pedestrian safety education program only (intervention group 2); or to no road safety intervention (comparison group). Quantification of the various road safety community/environmental activities undertaken in each community during the trial was measured, and a cumulative community activity index developed. Estimates of the volume and speed of vehicular traffic were monitored over a two year period.

RESULTS

Greater road safety activity was observed in intervention group 1 compared with the other groups. A significant reduction in the volume of traffic on local access roads was also observed over the period of the trial in intervention group 1, but not in the remaining groups.

CONCLUSIONS

The findings indicate that the various community/environmental interventions initiated in collaboration with CPIPP in intervention group 1 contributed, in part, to the observed reduction in the volume of traffic. A combination of community/environmental interventions and education are likely to reduce the rate of childhood pedestrian injury.

The PRECEDE-PROCEED model: application to planning a child pedestrian injury prevention program

OBJECTIVES

The objectives were first, to modify the PRECEDE-PROCEED model and to use it is as a basis for planning a three year intervention trial that aims to reduce injury to child pedestrians. A second objective was to assess the suitability of this process for planning such a relatively complex program.

SETTING

The project was carried out in 47 primary schools in three local government areas, in the Perth metropolitan area.

METHODS

The program was developed, based on extensive needs assessment incorporating formative evaluations. Epidemiological, psychosocial, environmental, educational, and demographic information was gathered, organised, and prioritised. The PRECEDE-PROCEED model was used to identify the relevant behavioural and environmental risk factors associated with child pedestrian injuries in the target areas. Modifiable causes of those behavioural and environmental factors were delineated. A description of how the model facilitated the development of program objectives and subobjectives which were linked to strategy objectives, and strategies is provided.

RESULTS

The process used to plan the child pedestrian injury prevention program ensured that a critical assessment was undertaken of all the relevant epidemiological, behavioural, and environmental information. The gathering, organising, and prioritising of the information was facilitated by the process.

CONCLUSIONS

The use of a model such as PRECEDE-PROCEED can enhance the development of a child injury prevention program. In particular, the process can facilitate the identification of appropriate objectives which in turn facilitates the development of suitable interventions and evaluation methods.

Which Prevention Strategies for Child Pedestrian Injuries? A Review of the Literature

In 1992, motor vehicle-related injury was the leading cause of injury-specific death in the United States for children aged zero to fourteen years. In the five to nine years age group, childhood pedestrian injury was exceeded only by motor vehicle occupant injuries as the leading cause of death. The prevention of these injuries is a multifactorial problem involving individual characteristics of the child, environmental design, and the mutual dependence between the child and his or her environment. This article considers the plethora of descriptive and analytical research and proposes suitable strategies to reduce the rate of child pedestrian injury.

Childhood pedestrian injuries: what can changes to the road environment achieve?

With the lack of any significant reduction in the mortality rates from pedestrian injury in Western Australia over the past decade, the need for efficacious prevention strategies is paramount. Using data from a case-control study of childhood pedestrian injuries, this study considered the effect on public health of an environmental initiative for prevention. Population-attributable risk proportions were calculated for the variables 'volume of traffic' and 'visual obstacles', which were found to predict the likelihood of pedestrian injury. The results suggest that 41 per cent (95 per cent confidence interval (CI) 13 to 62) of childhood pedestrian injuries can be attributed to volumes of traffic in excess of 10,000 vehicles per week, and 20 per cent (CI 11 to 48) of injuries can be attributed to visual obstacles on the street verge. It was also estimated that childhood pedestrian injuries could be reduced by up to 30 per cent if children's exposure to roads with volumes of traffic exceeding 10,000 vehicles per week, could be reduced to 15 per cent or less. Similarly, a reduction of up to 8 per cent could occur if visual obstacles on the roadside were reduced to 15 per cent. Changes to the road environment have potential to prevent injury to children.

Who's prepared for advocacy? Another inverse law

OBJECTIVES

To examine the characteristics of parents responding to a petition calling for greater efforts to ensure the safety of children as pedestrians and to contrast factors predictive of advocacy with risk factors for child pedestrian injury.

SETTING

The Auckland region of New Zealand.

METHODS

Parents participating in the Auckland Child Pedestrian Injury Study, a community based case-control study, were invited to support a series of recommendations based on the study results, by signing and returning a petition that was to be delivered to the New Zealand Minister for Transport. Characteristics of petitioners were determined by linking their petition responses to the study questionnaires using an unique identifier. The characteristics of petitioners and nonpetitioners were summarised using odds ratios.

RESULTS

31% of parents signed and returned the petition; 19% were parents of cases and 36% were parents of controls. The sociodemographic groups whose children were at the lowest risk of pedestrian injury were the most likely to return the petition. Children in the most disadvantaged socioeconomic group and children of Pacific Island parents were at greatest risk of injury but the parents of these children were the least likely to respond to the petition.

CONCLUSIONS

The frequency with which parents advocate for child safety varies inversely with the need for it. Models of health promotion based on community ownership and empowerment alone are unlikely to address the steep socioeconomic gradients in childhood injury mortality.