Mobilizing for pedestrian safety: an experiment in community action

The advocacy for pedestrian safety study: cluster randomised trial evaluating a political advocacy approach to reduce pedestrian injuries in deprived communities

OBJECTIVE

To determine whether advocacy targeted at local politicians leads to action to reduce the risk of pedestrian injury in deprived areas.

DESIGN

Cluster randomised controlled trial.

SETTING

239 electoral wards in 57 local authorities in England and Wales.

PARTICIPANTS

617 elected local politicians.

INTERVENTIONS

Intervention group politicians were provided with tailored information packs, including maps of casualty sites, numbers injured and a synopsis of effective interventions.

MAIN OUTCOME MEASURES

25-30 months post intervention, primary outcomes included: electoral ward level: percentage of road traffic calmed; proportion with new interventions; school level: percentage with 20 mph zones, Safe Routes to School, pedestrian training or road safety education; politician level: percentage lobbying for safety measures. Secondary outcomes included politicians' interest and involvement in injury prevention, and facilitators and barriers to implementation.

RESULTS

PRIMARY OUTCOMES DID NOT SIGNIFICANTLY DIFFER: % difference in traffic calming (0.07, 95%CI: -0.07 to 0.20); proportion of schools with 20 mph zones (RR 1.47, 95%CI: 0.93 to 2.32), Safe Routes to School (RR 1.34, 95%CI: 0.83 to 2.17), pedestrian training (RR 1.23, 95%CI: 0.95 to 1.61) or other safety education (RR 1.16, 95%CI: 0.97 to 1.39). Intervention group politicians reported greater interest in child injury prevention (RR 1.09, 95%CI 1.03 to 1.16), belief in potential to help prevent injuries (RR 1.36, 95%CI 1.16 to 1.61), particularly pedestrian safety (RR 1.55, 95%CI 1.19 to 2.03). 63% of intervention politicians reported supporting new pedestrian safety schemes. The majority found the advocacy information surprising, interesting, effectively presented, and could identify suitable local interventions.

CONCLUSIONS

This study demonstrates the feasibility of an innovative approach to translational public health by targeting local politicians in a randomised controlled trial. The intervention package was positively viewed and raised interest but changes in interventions were not statistically significance. Longer term supported advocacy may be needed.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN91381117.

Hispanic ethnicity and unintentional injury mortality in the elderly

BACKGROUND

Unintentional injury is a leading cause of preventable mortality in elderly populations and is most often related to accidental falls and motor vehicle accidents. Hispanic ethnicity has been previously associated with decreased risk of accidental fall death as well as improved outcomes in other health states, the "Hispanic paradox." A timely analysis of national data with consideration for multiple injury types and age could provide insight into this epidemiologic phenomenon and help guide the use of prevention efforts.

MATERIALS AND METHODS

Search of the Center for Disease Control's WISQARS database was performed to identify the number of fatalities in the U.S. between 2003 and 2006 by age group, gender, Hispanic ethnicity, and injury type. Total U.S. population and group populations for the years examined were obtained from the U.S. Census Bureau's American Community Survey for each year. Mortality was calculated as fatalities over the total group population for the years examined.

RESULTS

Independent of gender and age group, elderly Hispanics were at decreased risk of death from accidental fall or as an occupant in a motor vehicle accident, but increased risk of pedestrian fatality compared with white-NH.

CONCLUSIONS

The reduced fall and occupant mortality seen in elderly Hispanic populations may come at the cost of increased pedestrian-related mortality. This is consistent with and likely reflects differences in culture, socioeconomic status, and geographic distribution for the U.S. Hispanic population. Effective targeting of injury prevention programs, especially community based, should consider the role of Hispanic ethnicity and its impact on lifestyle.

Road traffic injuries among middle school students in a rural area of China

OBJECTIVE

Injuries resulting from road traffic crashes are a major and growing public health problem worldwide, disproportionately affecting vulnerable road users in developing countries. However, research on road traffic injuries in developing countries has been limited. We studied road traffic injuries among middle school students in a rural area of China.

METHODS

We surveyed 1551 students in Hunan province using a hard-copy survey questionnaire. The survey was conducted at two middle schools with the cooperation of teachers and school officials. The questionnaire gathered data including sociodemographics, school activities, and sleep patterns along with road traffic injuries among middle students during a 3-month recall period in 2006. Road traffic injuries were defined as injuries incurred as a result of a road traffic collision involving at least one vehicle in motion on a public or private road that resulted in at least one person being injured.

RESULTS

There were 56 road traffic injuries reported by the surveyed students yielding a rate of 3.6 percent over the 3-month period. The greatest percentage of those injuries involved a motorcycle (80%). Nearly two fifths of injuries resulted in a period of activity restriction lasting one day or more (39%). The multivariable logistic regression analysis indicated that there were statistically significant associations between the assignment of extra homework by parents (odds ratio [OR] = 3.78, 95% confidence intervals [CI] = 1.49-9.60, p-value < 0.01) and parents' treatment for poor academic performance (OR = 2.18, 95% CI = 1.18-4.02, p-value < 0.05) with road traffic injuries and difficulty falling asleep was a marginally a significant risk factor (OR = 2.03, 95% CI = 0.78-5.28, p-value = 0.06).

CONCLUSION

School-related stress and sleep disturbance were identified as possible risk factors for road traffic injuries among students in a rural area of China. Further research is warranted in order to develop prevention strategies to address these preventable injuries.

Prevention of self-immolation by community-based intervention

OBJECTIVE

To describe the effectiveness of a community-based program targeting prevention of self-immolation. Suicide by burning is rare in developed countries (0.1-1.8% of all suicides), but more frequent in developing countries (up to 41% of all suicides). Self-immolation constitutes from 0.4% to 40% of admissions to burn centers worldwide. During 2001, an average of 11 Iranians committed suicide daily, 4 of these being self-immolations (36%). Self-immolation caused from 4% to 28% of all admissions to Iranian burn centers. Approximately 80% of hospitalized self-immolation patients die. All descriptive self-immolation studies in Iran emphasize the need for implementing prevention programs.

DESIGN

Quasi-experimental.

SETTING

The Iranian cities Gilangharb (intervention) and Sarpolzahab (reference).

PARTICIPANTS

The populations of these communities.

METHODS

Hospital data collection on self-immolation patients and suicide attempts (all mechanisms) was made from 21 March 1999 to 20 March 2003. The first 12 months of the study provided baseline data, while the last 3 years comprised of a community-based intervention, using a mix of passive and active interventions. Videos showing victim stories were an important component in the prevention program. The interventions were particularly aimed at young women and socio-economically deprived groups, these being shown to be at high risk in earlier studies.

RESULTS

Compared to baseline, the mean self-immolation attempts rate decreased by 57% after the implementation of the intervention in Gilangharb (p=0.04, Yates corrected p=0.07). Correspondingly, the reference city rate decreased 27% (n.s.). Moreover, in Gilangharb a 19% decrease of suicide attempts (all mechanisms) was observed while the corresponding reference city rate increased by 24% (n.s.). While the suicide attempt rates were similar in the two populations during baseline, the mean rates observed during the intervention period differed significantly (p<0.0001).

CONCLUSIONS

A community prevention program targeting self-immolation can be effective. Local data and the showing of videos depicting victim stories from self-immolation attempts provided a stimulus for community action.

Motor vehicle crash pedestrian deaths in New York City: the plight of the older pedestrian

OBJECTIVE

To describe the epidemiology of pedestrian deaths due to motor vehicle crashes (MVCs) between age groups in New York City (NYC), with a comparison to national data.

METHODS

Review of MVC pedestrian deaths in NYC and the US from 1998 to 2002. Data on deaths were obtained from the National Highway Traffic Safety Administration.

RESULTS

Almost half (48%) of all MVC deaths in NYC were among pedestrians, compared with 12% nationally. Pedestrian death rates were highest among older age groups (> or =65 years). NYC's older pedestrians were more likely than US older pedestrians to be killed at an intersection, during daytime and on weekdays.

CONCLUSION

Older people constitute a major proportion of MVC pedestrian deaths in NYC. Conditions (such as traffic exposure) surrounding pedestrian MVCs may differ by age group. The high burden of MVCs among older pedestrians in NYC highlights the importance of local-level analysis to guide public health planning.

Suicide by self-immolation: comprehensive overview, experiences and suggestions

Suicide by burning is a rare condition in the developed countries (0.06-1% of all suicides) but is more frequent in the developing countries (accounting for as many as 40.3% of all suicides). In different parts of Iran, between 1.39% and 9.50% of patients that attempted suicide and 25.0% and 40.3% of patients who committed suicide were via deliberate self-burning. Self-burning (immolation) comprises between 0.37% and 40% of total burn center admissions around the world and, in Iran, it comprises between 4.1% and 36.6% of admissions in Iranian burn centers. Approximately 80% of hospitalized self-immolation patients die. The goal of this study was to identify the epidemiologic features, causes, and potential protective factors regarding suicide by burning in Kermanshah province, in the west of Iran, and to develop the effective intervention programs based on the Public Health Approach to Prevention. During the course of a year, from March 21, 2004, to March 20, 2005 (based on the Iranian calendar), the author examined all the suicidal patients who were admitted to the emergency department of hospitals in Kermanshah University of Medical Science. Examination included a retrospective cross-section study, via demographic questionnaires and suicidal checklists. During the period of study, 1820 patients who attempted suicide and 90 patients who successfully committed suicide were admitted. A total of 41% (37 cases) of patients who committed suicide were via self-immolation. Of these, 81% of self-immolation patients were female (P < .0005), and the female:male ratio was 4.3:1. A total of 86.5% of the patients were in the 11 to 30 years of age group. The mean age was 24.9 years (range, 14-50 years). Forty-nine percent of cases were single, 84% were illiterate or had a low level of education, 78.5% were housewives, and 14% were unemployed. Also, most of the patients (53%) were living in rural area, 97% did not have a previous history of suicide attempt, and 67.5% regretted their self-immolation act. The majority of the self-immolations (64.8%) occurred during daylight hours, and the most common self-immolation motivation factor was marital conflict (32.5%). Overall, this study demonstrates that self-immolation should be considered as a mental health problem in our society, and it is necessary to implement programs and strategies to prevent it. The public health approach provides a framework for a National Prevention Strategy to address this serious national problem. Local data on victims and victim stories from self-immolation provided the stimulus for community action.

Local stakeholders' perspectives on improving the urban environment to reduce child pedestrian injury: implementing effective public health interventions at the local level

Local-level public health interventions require action from multiple agencies, organizations and individuals, yet little is known about how best to work with stakeholders to facilitate change. We sought local stakeholders' perspectives on how best to address impediments to implementing interventions designed to reduce child pedestrian injury by improving the pedestrian environment. We conducted 20 in-person, key informant interviews with people who would be the likely advocates for environmental change to improve the pedestrian environment in one US city, Baltimore, Maryland. We discuss the importance of reframing child pedestrian injury risk as a livability issue, increasing awareness about the potential impact of environmental changes to improve public safety, and the need for a formal efficient process to facilitate communication between local government and other stakeholders. These findings provide public health professionals and advocates with useful insight into how local stakeholders view the issue and their perspectives on how best to achieve change.

Risk of vehicle-pedestrian and vehicle-bicyclist collisions among children with disabilities

OBJECTIVES

To examine the potential association between disability and risk of vehicle-pedestrian and vehicle-bicyclist collisions among children.

METHODS

Data from the 2002 National Transportation Availability and Use Survey for Persons with Disabilities (NTAUSPD) were analyzed.

RESULTS

Among 5019 persons who completed the survey, there were a total of 687 children between 5-17 years of age, including 299 respondents with and 388 without disabilities. After controlling for potential confounding variables, children with disabilities were more than five times more likely to have been hit by a motor vehicle as a pedestrian or bicyclist than children without disabilities (adjusted OR = 5.53, 95% confidence interval (CI): 1.43-21.41). For all children, regardless of their disability status, children who reported having some difficulty with traffic had a significantly higher risk of collisions (adjusted OR = 50.71, 95% CI: 7.35-349.86). The most commonly reported traffic difficulties for all children with and without disabilities were "Too few or missing sidewalks/paths," "Do not know when it's safe to cross," and "Insensitive/unaware drivers."

CONCLUSIONS

Existing effective transportation safety interventions should be effective in reducing the risk of vehicle-pedestrian and vehicle-bicyclist collisions in children with disabilities. Future research and safety interventions should focus on how to promote the use of existing effective transportation safety interventions among children with disabilities and their families.

Using marginalization theory to examine pedestrian injury: a case study

Hall, Stevens, and Meleis' critical feminist theory of marginalization provides a useful lens through which to examine both the role of the automobile in Western society and the related phenomenon of automobile-pedestrian injury. This article draws on a specific case of automobile-pedestrian fatality in San Francisco's Mission District to show how the marginalization of neighborhoods, groups, and individuals occurs in an autocentric environment. Nurses can use concepts of marginalization to inform and dialogue with communities about healthier, safer transportation options and ways to achieve them.