Understanding high traffic injury risks for children in low socioeconomic areas: a qualitative study of parents' views

Crashes involving distracted pedestrians: Identifying risk factors and their relationships to pedestrian severity levels and distraction modes

The concept of distracted pedestrians and its impact on highway safety has gained increasing attention in recent years. However, studies focusing exclusively on distracted pedestrian crashes are less pervasive than distracted driving. In addition, most prior studies investigate the harmful effect of cellphone usage while walking, without considering other forms of pedestrian distraction. Also, the existing literature provides limited knowledge on comprehending the affinities between pedestrian distraction and safety consequences. This study aims to reveal the chain of contributing factors involved in distracted pedestrian crashes, considering both pedestrian severity levels and specific distraction-related tasks. Ten years (2010-2019) of related crashes were extracted from the Louisiana Department of Transportation and Development (LADOTD) database, and association rule mining (ARM) was applied to identify the meaningful crash patterns. Different distracting activities of pedestrians were introduced from the narratives of police-investigated crash reports. The study findings exhibit the complex nature of distracted pedestrian crashes by highlighting the intricate relationships between risk factors. On road segments, distracted male pedestrians aged 41-64 were more likely to be fatal/severely injured in dark-not-lighted conditions. Crashes involving pedestrians using electronic devices were often found at intersections. Distractions caused by pets, persons, or objects were strongly associated with crossing segments in rural settings. In-person conversation while standing on roadways in urban residential locations without traffic controls was found to increase vulnerability. Working on vehicles while wearing dark clothes and in dark-not-lighted conditions was identified as an influential factor in crash occurrence. Moreover, careless or inattentive actions of pedestrians while playing on the road segments were associated with a high likelihood of crashes. These study outcomes are crucial in uncovering the coexisting crash characteristics related to distracted pedestrians, which can be helpful in targeting and developing effective educational, design, and enforcement strategies to improve pedestrian safety.

A decade of child pedestrian safety in England: a bayesian spatio-temporal analysis

BACKGROUND

Child pedestrian injury is a public health and health equality challenge worldwide, including in high-income countries. However, child pedestrian safety is less-understood, especially over long time spans. The intent of this study is to understand factors affecting child pedestrian safety in England over the period 2011-2020.

METHODS

We conducted an area-level study using a Bayesian space-time interaction model to understand the association between the number of road crashes involving child pedestrians in English Local Authorities and a host of socio-economic, transport-related and built-environment variables. We investigated spatio-temporal trends in child pedestrian safety in England over the study period and identified high-crash local authorities.

RESULTS

We found that child pedestrian crash frequencies increase as child population, unemployment-related claimants, road density, and the number of schools increase. Nevertheless, as the number of licensed vehicles per capita and zonal-level walking/cycling increase, child pedestrian safety increases. Generally, child pedestrian safety has improved in England since 2011. However, the socio-economic inequality gap in child pedestrian safety has not narrowed down. In addition, we found that after adjusting for the effect of covariates, the rate of decline in crashes varies between local authorities. The presence of localised risk factors/mitigation measures contributes to variation in the spatio-temporal patterns of child pedestrian safety.

CONCLUSIONS

Overall, southern England has experienced more improvement in child pedestrian safety over the last decade than the northern regions. Our study revealed socio-economic inequality in child pedestrian safety in England. To better inform safety and public health policy, our findings support the importance of a targeted system approach, considering the identification of high-crash areas while keeping track of how child pedestrian safety evolves over time.

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.

Research on intervention methods for children's street-crossing behaviour: Application and expansion of the theory of "behaviour spectrums"

Due to immaturity in their physical and cognitive development, children are particularly vulnerable to road traffic injuries as pedestrians. Child pedestrian injury primarily occurs in urban areas, with a significant share at crosswalks. The aim of this study is to explore whether an intervention programme based on the theory of "behaviour spectrums" can improve the street-crossing skills of primary school children. Children were recruited near a local primary school through invitation letters and were randomly divided into two groups: a control group (n = 10, no intervention) and an experimental group (n = 10, intervention). The children in the experimental group received 30-45 min of training. The child participants were asked to wear an eye tracker and performed a crossing test in a real-world street environment; in this test, they were required to successively pass through an unsignalised intersection, an unsignalised T-intersection and a signalised intersection on a designated test route. A high-definition camera was used to record the children's crossing behaviour, and the Tobii Pro Glasses 2 eye tracker was used to derive indicators of the children's visual behaviour in the areas of interest (AOIs) in the street. The evaluation was conducted on children's crossing behaviour in the control group (which received no intervention) and the experimental group (tested at two time points after the intervention: children tested immediately after the intervention and children retested one month after the intervention). The results showed that compared with the control group, the children in the experimental group no longer focused on the small area around the body (e.g., the zebra crossing area) and the area in front of the eyes (e.g., the sidewalk area), which increased their visual attention to the traffic areas on the left and right sides of the zebra crossing; thus, unsafe crossing behaviour was reduced in the experimental group. Compared with the experimental group immediately after the intervention, the intervention effect on some indicators showed a significant weakening trend in the retest of the experimental group one month later. Overall, the results show that an intervention programme based on the theory of "behaviour spectrums" can improve children's crossing skills. This study provides valuable information for the development and evaluation of intervention programmes to improve children's street-crossing skills.

Meta-synthesis of qualitative evidence in road traffic injury prevention: a scoping review of qualitative studies (2000 to 2019)

BACKGROUND

A considerable number of qualitative studies have been published in recent years on the issues that the quantitative studies have limitations on. This study aimed at performing a meta-synthesis on qualitative studies on Road Traffic Injuries (RTIs) with a scoping review approach.

METHODS

This meta-synthesis study was conducted as a scoping review in 2019. The Arkesy and O'Malley framework was applied which has six steps of identifying the research question, identifying the relevant studies, selecting the studies, charting the data, data analysis and reporting the results, and consultation exercise. The required data were gathered by searching the relevant keywords in databases of PubMed, web of knowledge, Scopus, Cochrane Library, Science Direct, Google scholar, Sid, IranMedex. Extracted data were analyzed by the Content-Analysis method.

RESULTS

Finally, 30 studies were included. Extracted data summarized in five main themes and 17 sub-themes. The main themes were: consequences (individual, family, social, financial), the needs of survivors (social support and healthcare), risk factors (general risk factors, risk factors for motorcyclists, risk factors for children and adolescents), barriers of prevention (general barriers, pre-hospital barriers, emergency, and hospital barriers), and prevention solutions (increasing safety, rules and regulations, education, increasing equipment, scientific solutions) of RTIs.

CONCLUSION

This study combined the methods of the scoping review and the meta-synthesis to mapping all qualitative studies on the RTIs, with this approach, this study provides extensive and practical information for policy-makers, managers, practitioners, and researchers in the field of RTIs. Also, by applying this approach, the gaps in the existing knowledge and areas in need of further research are identified.

Neighbourhood characteristics associated with child pedestrian fatalities in Johannesburg, South Africa

The present study investigated the relationship between neighbourhood characteristics and childhood pedestrian fatalities (2001-2010) in Johannesburg, South Africa. This cross-sectional study used negative binomial regression models. Results indicate that: areas with high concentrated disadvantage have elevated childhood pedestrian deaths, especially for those aged 5 to 9 years. Areas marked by residential mobility are associated with high pedestrian deaths among children 0 to 4 years. Black childhood pedestrian deaths are higher in areas marked by a high concentration of female-headed households. The analyses highlight the value of further exploring the effects of neighbourhood characteristics and suggest points of entry for interventions to reduce or prevent childhood pedestrian traffic mortality.

Behavioral Health at School: Do Three Competences in Road Safety Education Impact the Protective Road Behaviors of Spanish Children?

Background: Education in road safety (also known as Road Safety Education-RSE) constitutes, nowadays, an emergent approach for improving present and future road behaviors, aiming at taking action against the current, and concerning, state-of-affairs of traffic crashes, through a behavioral perspective. In the case of children, and despite their overrepresentation in traffic injury figures, RSE-based strategies for behavioral health in transportation remain a "new" approach, whose impact still needs to be empirically tested. Objective: The aim of this study is to assess the impact of three key road safety skills of the Positive Attitudes, Risk perception and Knowledge of norms (PARK) model, addressed in RSE-based interventions, on the safe road behavior of Spanish children. Methods: For this cross-sectional study, a representative sample of 1930 (50.4% males and 49.6% females) Spanish children attending primary school, with a mean age of 10.1 (SD = 1.6) years, was gathered from 70 educational centers across all Spanish regions, through a national study on RSE and road safety. Results: Road safety skills show a positive relationship with children's self-reported safe behaviors on the road. However, the knowledge of traffic norms alone does not predict safe behaviors: it needs to be combined with risk perception and positive attitudes towards road safety. Furthermore, the degree of exposure to previous RSE interventions was shown to have an effect on the score obtained by children in each road safety skill; on the other hand, road misbehaviors observed in parents and peers had a negative impact on them. Conclusion: The outcomes of this study suggest that education in road safety is still a key process for the acquisition of safe habits, patterns and behaviors among young road users.

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.

Parental supervision and discomfort with children walking to school in low-income communities in Cape Town, South Africa

OBJECTIVE

The risk of pedestrian injury is compounded for children living in low-income communities due to factors such as poor road and pedestrian infrastructure, reliance on walking as a means of transport, and compromised supervision. Parents play an important role in child pedestrian safety. The primary objective of this study was to examine the effects of child pedestrian variables on parental discomfort with regard to letting their child walk to and from school and on the frequency of adult supervision.

METHODS

A cross-sectional study was conducted using a convenience sample from 3 schools participating in a pedestrian safety school initiative. The schools are situated in low-income, high-risk communities in the City of Cape Town. A parent survey form was translated into isiXhosa and sent home with learners to those parents who had consented to participate. The response rate was 70.4%, and only parents of children who walk to and from school were included in the final sample (n = 359). Child pedestrian variables include the time taken to walk to school, parental rating of the child's ability to safely cross the road, and the frequency of adult supervision.

RESULTS

More than half of parents reported that their child walked to and from school without adult supervision. About 56% of children took less than 20 min to walk to school. Most parents (61%) were uncomfortable with their child walking to school, although the majority of parents (55.7%) rated their child's ability to cross the road safely as better or significantly better than average (compared to peers). The parents did not perceive any differences in pedestrian risk factors between boys and girls or between younger (6-9 years) and older (10-15 years) children. The time spent by a child walking to school and parents' perceptions of their child's road-crossing ability were found to be significant predictors of parental discomfort (in letting their child walk). Younger children and children who spent less time walking were more likely to be supervised by an adult.

CONCLUSIONS

Many South African schoolchildren have to navigate the roads without adult supervision from a young age. Caregivers, especially in low-income settings, often have limited options with regard to getting their child to school safely. Regardless of the child's age and gender, the time that they spend on the roads is an important factor for parents in terms of pedestrian safety.

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.

Analyzing and modeling risk exposure of pedestrian children to involvement in car crashes

This paper analyzes the various variables affecting pedestrian children road crashes, placing emphasis on the effect of daily activity patterns and the built environment, including the children's residential neighborhoods and the land use of the places where they conduct their activities. Two complementary data sources from the case study of an Arab town in northern Israel were used to provide a holistic picture of child-pedestrian road crashes: police files providing detailed analyzes of the reason for each crash, its location, and the characteristics of the driver involved; and a survey of 199 households with both involved and not involved children in road crashes, including a one-day travel diary. The study found that a combination of three groups of variables affects child-pedestrian road crashes: socio-economic status, travel patterns, and land use. Most vulnerable are boys from a low socio-economic group who live in areas of high density and mixed land use near a major road and who tend to walk to and from school and additional activities after school.

Does playground improvement increase physical activity among children? A quasi-experimental study of a natural experiment

Outdoor recreational spaces have the potential to increase physical activity. This study used a quasi-experimental evaluation design to determine how a playground renovation impacts usage and physical activity of children and whether the visitations correlate with children's physical activity levels and parental impressions of the playground. Observational data and intercept interviews were collected simultaneously on park use and park-based activity among playground visitors at pre- and postrenovation at an intervention and a comparison park during three 2-hour periods each day over two weeks. No detectable difference in use between parks was observed at followup. In the intervention park, attendance increased among boys, but decreased among girls although this (nonsignificant) decline was less marked than in the comparison park. Following renovation, there was no detectable difference between parks in the number of children engaged in MVPA (interaction between park and time: P = 0.73). At the intervention park, there was a significant decline in girls engaging in MVPA at followup (P = 0.04). Usage was correlated with parental/carer perceptions of playground features but not with physical activity levels. Renovations have limited the potential to increase physical activity until factors influencing usage and physical activity behavior are better understood.

Engaging the Somali community in the road safety agenda: a process evaluation from the London borough of Hounslow

In the UK the most disadvantaged in society are more likely than those more affluent to be injured or killed in a road traffic collision and therefore it is a major cause of health inequality. There is a strong link between ethnicity, deprivation and injury. Whilst national road traffic injury data does not collect ethnic origin the London accident and analysis group does in terms of broad categories such as 'white', 'black' and 'Asian'. Analysis of this data revealed the over-representation of child pedestrian casualties from a 'black' ethnic origin. This information led road safety practitioners in one London borough to map child pedestrian casualties against census data which identified the Somali community as being particularly at risk of being involved in a road traffic collision. Working with the community they sought to discuss and address road safety issues and introduced practical evidence based approaches such as child pedestrian training. The process evaluation of the project used a qualitative approach and showed that engaging with community partners and working across organisational boundaries was a useful strategy to gain an understanding of the Somali community. A bottom approach provided the community with a sense of control and involvement which appears to add value in terms of reducing the sense of powerlessness that marginalised communities often feel. In terms of evaluation, small projects like these, lend themselves to a qualitative process evaluation though it has to be accepted that the strength of this evidence may be regarded as weak. Where possible routine injury data needs to take into account ethnicity which is a known risk factor for road casualty involvement which needs to be continually monitored.

Exposure to traffic and risk of hospitalization due to injuries

Research on the risk of motor vehicle injuries and their relationship with the amount of travel has been only partially analyzed. The few individual exposure assessments are related to very specific subsets of the driving and traveling populations. This study analyzes the relationship between kilometers traveled and hospitalization due to motor vehicle injuries. Twelve thousand three hundred and sixty nine Spanish university graduates from the Seguimiento Universidad de Navarra multipurpose cohort study were evaluated. They had not been hospitalized due to motor vehicle injuries at baseline and were followed up to eight years. Biannual questionnaires allowed for self-reporting of kilometers traveled in motor vehicles, together with incidence of hospitalization. Covariates in the Cox regression models included age and gender and baseline use of safety belt while driving, driving a vehicle with driver-side airbag, driving a motorcycle, and drinking and driving. There were 49,766 participant-years with an average yearly travel of 7,828 km per person-year. Thirty-six subjects reported a first hospitalization event during this time. The adjusted hazard ratio per additional kilometer traveled was 1.00005 (95% confidence interval 1.000013 to 1.000086). Even the smallest of reductions in the amount of kilometers traveled (from an average of 3,250 km per year to 1,000) has a statistically significant protective effect on the likelihood of sustaining hospitalization due to motor vehicle injury (aHR 0.9, 95% CI 0.78 to 0.98). In light of current policies aimed to reduce motorized traffic due to environmental concerns, it may be appropriate to consider the additional health benefit related to reductions in injuries.