Preventing Child Pedestrian Injury: A Guide for Practitioners

Safety on the Line: Examining the impacts of crosswalk design on Child's perceived Safety, cautious Behavior, and visual attention with VR Technology

Although children are particularly vulnerable to accidents while crossing a street, knowledge about their specific perceptual and behavioral responses to crosswalk design and conditions is limited. By employing simulated virtual reality (VR) experiments, this study investigated how the environment of an unsignalized T-junction in a school zone influenced the perceived safety, crossing behaviors, and visual attention of 178 participants, consisting of younger (aged 8-10) and older children (aged 11-12) and their parents. Key findings from cross-classified multilevel, trajectory, and counterfactual analyses using Reproduced Virtual Experiment Data (CARVED) techniques for viewed scene comparisons are as follows. First, despite their physical and cognitive limitations, children-particularly younger ones-exhibited fewer attentive behaviors on sidewalks and roadways, along with a higher informal crossing ratio than parents. Second, responses to environmental conditions varied by developmental stage. While older children and parents generally responded to hazardous conditions with increased caution, younger children exhibited minimal behavioral adjustments. For example, parents perceived environments with parked cars as less safe and demonstrated more attentive and preventive behaviors on roadways. In contrast, younger children, despite having their line of sight obstructed, failed to recognize these hazards and did not adopt compensatory strategies, reinforcing their vulnerability. Similarly, only older children and parents perceived decorative crosswalk patterns as less safe than traditional ones. Third, while traditional crosswalks facilitated orthogonal crossings and provided clearer guidance for safer movements, decorative patterns often encouraged diagonal and dispersed crossings, resulting in a higher jaywalking ratio. Lastly, speed limits showed no significant influence on perceived safety or crossing behaviors. These findings highlight the critical influence of developmental stages on safety perceptions and behaviors, emphasizing the need to reassess crosswalk designs and address visibility challenges caused by illegal on-street parking to enhance child pedestrian safety.

External causes of death in younger than 18 years old in Portugal in the last 10 years - a retrospective analysis

Pediatric mortality from external causes has been a worldwide concern in the last decades. In particular, the prevalence of accidental deaths is a key concern, especially traffic accidents. This is retrospective study based on autopsy reports of violent deaths in individuals younger than 18 years from 2014 to 2023 in Portugal, aimed at providing valuable insight in order to help formulate preventive strategies. There were 554 pediatric deaths due to exogenous causes, with a predominance of males (68,95%). Adolescents were the most prevalent age group. The leading cause of death was land transport injury (38,27%). Asphyxia-related deaths were predominant in younger age groups. Accidental deaths accounted for 76,71% of all cases. Preventable injury-related causes continue to be a major contributor to child mortality. The inconsistent mortality rates from various mechanisms emphasize the necessity for targeted and effective preventive measures. Above all, land transport accidents seem to be an issue in need of prompt intervention.

Exploring the impact of built environment on traffic risk perception of school-aged children: A case study of old residential neighborhoods in Changsha City, Hunan Province, China

The built environment of old residential neighborhoods poses heightened perceived traffic risks for school-aged children due to their limited cognitive ability to assess hazards, underdeveloped understanding of traffic patterns, and inadequate infrastructure in these areas. However, studies on the impacts of neighborhood environments on children's traffic risk perceptions remain limited. This study aims to reveal the influence of individual attributes, as well as macro- and micro-level environmental factors, on children's risk perception using a hierarchical ordered logit model with random effects. Data were collected through a questionnaire survey of 404 school-aged children across fifty old residential neighborhoods in Changsha, China. The results indicated that girls generally perceive higher levels of traffic risk than boys. At the macro-level, low population density and high activity facilities coverage were associated with reduced risk perceptions among children. At the micro-level, obstructed views of intersections, curbside parking, and road damage were found to increase risk perceptions among children. Additionally, random effects related to gender, intersection type, intersection visibility, curbside parking, and sidewalk availability suggested the influence of unobserved factors. The findings underscore the need for targeted interventions, such as improving intersection visibility, managing curbside parking, and repairing road damage, to mitigate traffic risks. Policymakers and urban designers should focus on these aspects to enhance safety and create child-friendly residential environments.

Trends and characteristics of severe road traffic injuries in children: a nationwide cohort study in Japan

PURPOSE

The purpose of this study was to evaluate temporal trends of characteristics of severe road traffic injuries in children and identify factors associated with mortality using a nationwide database in Japan.

METHODS

We performed a retrospective analysis of Japan Trauma Data Bank (JTDB) from 2004 to 2018. We included patients with traffic injuries under the age of 18 who were hospitalized. The primary outcome was in-hospital mortality. We evaluated trends in characteristics and assessed factors associated with in-hospital mortality using a logistic regression analysis.

RESULTS

A total of 4706 patients were analyzed. The most common mechanism of injury was bicycle crash (34.4%), followed by pedestrian (28.3%), and motorcycle crash (21.3%). The overall in-hospital mortality was 11.2%. We found decreasing trends in motorcycle crash and in-hospital mortality and increasing trends in rear passenger seats in cars over the 15-year period. The following factors were associated with in-hospital mortality: car crash (aOR 1.69, 95%CI 1.18-2.40), pedestrian (aOR 1.50, 95%CI 1.13-1.99), motorcycle crash (aOR 1.42, 95%CI 1.03-1.95) [bicycle crash as a reference]; concomitant injuries to head/neck (aOR 5.06, 95%CI 3.81-6.79), thorax (aOR 2.34, 95%CI 1.92-2.87), abdomen (aOR 1.74, 95%CI 1.29-2.33), pelvis/lower-extremity (aOR 1.57, 95%CI 1.23-2.00), spine (aOR 3.01, 95%CI 2.02-4.43); and 5-year increase in time period (aOR 0.80, 95%CI 0.70-0.91).

CONCLUSIONS

We found decreasing trends in motorcycle crash and in-hospital mortality, increasing trends in rear passenger seats in cars over the 15-year period, and factors associated with in-hospital mortality such as type of mechanisms and concomitant injuries. Strengthening child road safety measures, particularly for rear passenger seats in vehicles, is imperative to enhance our dedication to injury prevention.

Developmental changes in how pedestrians cross streets in single- vs. dual-lane traffic conditions

OBJECTIVE

Pedestrian injury is a leading contributor to childhood deaths. This study compared the crossing behaviors of children with adults when crossing in virtual single-lane vs. two-lane traffic conditions.

METHOD

Using a fully immersive virtual reality system, children 7-10 years and adults crossed streets with traffic in one lane (near lane) or in two lanes (near and far lane) with 0 offset so cars from opposing directions arrived at the child's crossing line at the same time. On each trial, pedestrians made a decision on when to cross and then completed the crossing, with measures of attention and crossing behaviors automatically recorded by the system as they did so.

RESULTS

In comparison to crossing a single lane of traffic, crossing two-lane roads increased injury risk for all pedestrians, though children experienced significantly greater risk than adults. Children predominantly crossed by stopping before entering the far lane, whereas adults showed greater synchronization of self-movement to traffic flow and more often crossed both lanes without stopping.

CONCLUSIONS

Children experience more high-risk outcomes than adults when crossing single-lane roads. Crossing two-lane roads elevates risk for pedestrians of both ages, though this risk is significantly greater for child than adult pedestrians. The predominant strategy used to cross two lanes of traffic shows significant developmental changes. Implications for injury prevention are discussed.

Road Fatalities in Children Aged 0-17: Epidemiological Data and Forensic Aspects on a Series of Cases in a Single-Centre in Romania

INTRODUCTION

Road Traffic Accidents (RTAs) are the leading cause of premature death in young people aged 5-29. Globally, 186,300 children aged 9 years and under die from RTAs each year. Romania had the highest mortality rate in children aged 0 to 14 for 2018-2020. This study aimed to assess the involvement of children aged 0-17 years in fatal RTAs by analyzing medico-legal autopsy records in a 5-year period at Timisoara Institute of Legal Medicine (TILM), Romania.

MATERIALS AND METHODS

A retrospective analysis of medico-legal autopsy records of road fatalities in children aged 0-17 years, from TILM in a 5-year period (2017-2021), was conducted.

RESULTS

Of all medico-legal autopsies in the 5-year period, 23 cases (5.8%) involved road fatalities in children aged 17 and under. Preschoolers accounted for 10 cases, followed by the age group 15-17 years (n = 9). Most children sustained fatal injuries as passengers (n = 13), followed by child pedestrians (n = 7). This research follows four representative cases, each being a different type of child road fatality regarding the type of road user, the age of the victim, and the involvement of other risk factors.

CONCLUSIONS

Our findings emphasize the tragedy of road fatalities in children and the need to determine risk factors and prevention strategies to reduce the enormous global crisis involving these vulnerable victims.

Child pedestrian safety training in virtual reality: How quickly do children achieve adult functioning and what individual differences impact learning efficiency?

INTRODUCTION

Pedestrian injuries represent a leading cause of child death globally. One prevention strategy is teaching children street-crossing skills. Virtual reality (VR) has emerged as a strategy to offer repeated street-crossing practice and overcome ethical barriers of training children in live traffic. This study addressed two questions pertinent to implementation of child pedestrian safety training within VR: (a) how much training do children require to achieve adult street-crossing competency, and (b) what individual differences might facilitate children to acquire that competency more efficiently?

METHODS

Five hundred 7- and 8-year-olds were recruited. Children completed pedestrian safety training within VR for up to 25 thirty-minute training sessions until they achieved adult levels of mastery. At baseline, four cognitive-perceptual skills (visual memory, visual perception, processing speed, working memory) and parent-reported externalizing symptomatology were assessed.

RESULTS

On average, children achieved adult pedestrian safety competency after 10.0 training sessions (SD = 4.8). Just one child (<1%) failed to achieve adult pedestrian functioning after 25 training sessions. In univariate analyses, boys took slightly longer than girls to achieve adult functioning, and visual memory, visual perception, processing speed, working memory, and fewer externalizing symptoms were all positively associated with shorter time to mastery. In a multivariable model, only child age was a statistically significant predictor.

CONCLUSION

Almost all participants achieved adult street-crossing skills competency through VR training, although they required about 10 sessions on average. Analysis of predictor variables confirmed that nearly all 7- and 8-year-olds are trainable.

PRACTICAL APPLICATION

Implementation of VR pedestrian safety training is recommended, but must be conducted cautiously to ensure children are not permitted to engage independently in traffic until they are assessed and demonstrate sufficient skills.

A Feasibility Randomized Trial Evaluating Safe Peds: A Virtual Reality Training Program to Teach Children When to Cross Streets Safely

OBJECTIVE

Injury as pedestrians is a leading contributor to childhood deaths. This study evaluated the effectiveness of Safe Peds, a fully immersive virtual reality training program to teach children when to cross street safely, with the focus on a number of foundational skills and practicing these in traffic situations of varying complexity.

METHODS

Children 7-10 years old were randomly assigned to a control (N = 31) or intervention (N = 26) group. Eligibility criteria included English speaking and typically developing. Testing took place on campus. All children completed pre- and post-testing measures, with those in the intervention group receiving training in between. Training comprised 1 session with 3 phases for a total of up to 1.5 hr and was tailored to each child's performance over trials. On each trial, children decided when to cross and fully executed this crossing, with measures automatically taken by the system as they did so.

RESULTS

Negative binomial regression and analysis of covariance tests were applied, predicting post-test scores while controlling for pre-test scores, age, and sex. The intervention was effective in improving children's street crossing skills, including stopping and checking skills (stop at the curb, look left/right/left, check for traffic before crossing the yellow line), and choosing safe inter-vehicle gaps. Children in the control group did not show significant improvements in any crossing skills.

CONCLUSIONS

The Safe Peds program effectively teaches children skills to support their deciding when to safely cross in a variety of traffic situations. Implications for pedestrian injury are discussed.

Injury and fatality risks for child pedestrians and cyclists on public roads

BACKGROUND

Pedestrians and cyclists are often referred to as "vulnerable road users," yet most research is focused on fatal crashes. We used fatal and nonfatal crash data to examine risk factors (i.e., relationship to an intersection, urbanicity, crash circumstances, and vehicle type) for police-reported pedestrian and cyclist injuries on public roads among children aged 0-9 and aged 10-19. We also compared risk factors among these two age groups with adults aged 20-29 and aged 30-39.

METHODS

Crash data were obtained for 2016-2020 from the National Highway Traffic Safety Administration's Fatality Analysis Reporting System for fatal crash injuries and Crash Report Sampling System for nonfatal crash injuries. We collected data on victim demographics, roadway, and vehicle- and driver-related factors. Descriptive analyses were conducted between and within pedestrian and cyclist victims.

RESULTS

We analyzed 206,429 pedestrian injuries (36% in children aged 0-19) and 148,828 cyclist injuries (41% in children aged 0-19) from 2016 to 2020. Overall, child pedestrians had lower injury rates than adults, but children aged 10-19 had greater cycling crash rates than adults. Almost half of the pedestrian injuries in children aged 0-9 were "dart-out" injuries (43%). In the majority of the cyclist injuries, children in both age groups failed to yield to vehicles (aged 0-9 = 40% and aged 10-19 = 24%). For children and all ages included in the study, the fatality risk ratio was highest when pedestrians and cyclists were struck by larger vehicles, such as trucks and buses. Further exploration of roadway factors is presented across ages and transportation mode.

CONCLUSION

Our findings on child, driver, vehicle, and roadway factors related to fatal and nonfatal pedestrian and cyclist injuries may help to tailor prevention efforts for younger and older children.

Traffic Accidents in Children and Adolescents: A Complex Orthopedic and Medico-Legal Approach

Traffic accidents involving children and adolescents present complex challenges from both the medico-legal and orthopedic standpoints. Despite the implementation of road traffic safety laws, pediatric road traffic injuries continue to be a significant contributor to mortality rates, physical harm, and hospitalization on a global scale. For children and young people, automobile accidents are considered to be the primary culprit of mortality in developed nations. Even in highly developed nations, trauma is a significant factor in infant mortality. Each age category, from childhood to young adulthood, has its fracture patterns, as their skeletons are considerably different from those of adults. The consequences of traffic accidents extend beyond the immediate physical trauma. The medico-legal aspects surrounding these incidents add another layer of complexity, as legal repercussions may affect the responsible adult or parent, particularly in cases involving child fatalities. To effectively address traffic accidents in children and adolescents, a comprehensive approach is necessary. This approach should involve not only medical professionals but also legal experts and policymakers. Collaboration between orthopedic specialists, medico-legal professionals, law enforcement agencies, and relevant government bodies can facilitate the development and implementation of strategies aimed at prevention, education, the enforcement of traffic laws, and improved infrastructure. By addressing both the medical and legal aspects, it is possible to enhance road safety for children and adolescents, reducing the incidence of injuries and their associated long-term consequences. In this review, we aimed to summarize traffic accidents in children and adolescents from a complex orthopedic and medico-legal approach.

Pedestrian Deaths During the COVID-19 Pandemic

The COVID pandemic provides a natural experiment examining how a 50-60% reduction in pedestrian activity might lead to a reduction in pedestrian deaths. We assessed whether the reduction in pedestrian deaths was proportional to a one-to-one matching presumed in statistics correlating mobility with fatality. The primary analysis examined New York (largest city in US), and the validation analysis examined Toronto (largest city in Canada). We identified pedestrian activity in each location from the Apple Mobility database, normalized to the baseline in January 2020. We calculated monthly pedestrian deaths from the Vision Zero database in each city with baseline data from 3 prior years. We found a large initial reduction in pedestrian deaths during the lockdown in New York that was transient and not statistically significant during the summer and autumn despite sustained reductions in pedestrian activity. Similarly, we found a large initial reduction in pedestrian deaths during the lockdown in Toronto that was transient and not sustained. Together, these data suggest the substantial reductions in pedestrian activity during the COVID pandemic have no simple correlation with pedestrian fatality counts in the same locations. An awareness of this finding emphasizes the role of unmeasured modifiable individual factors beyond pedestrian infrastructure or other structural contributors.

Relationship of pedestrian crash types and passenger vehicle types

INTRODUCTION

This is the first known study that examines the association between common pedestrian crash types and passenger vehicle types.

METHOD

The analysis included single-vehicle, single-pedestrian crashes from two data sets: North Carolina state crash data and the Fatality Analysis Reporting System (FARS). We performed separate multinomial logistic regression analyses of major pedestrian crash types occurring at or near intersections and at nonintersections.

RESULTS

At or near intersections, minivans, large vans, pickups, and SUVs (collectively known as light truck vehicles, or LTVs) were more likely than cars to be involved in crossing-roadway-vehicle-turning-left crashes versus crossing-roadway-vehicle-not-turning crashes. LTVs were also more likely involved in fatal crossing-roadway-vehicle-turning-right crashes at or near intersections versus crossing-roadway-vehicle-not-turning crashes when compared with cars. At nonintersections, LTVs were associated with increased odds of walking-along-roadway crashes relative to crossing-roadway-vehicle-not-turning crashes when compared with cars.

CONCLUSIONS

LTVs were more likely to be involved in certain pedestrian crash types, implying a potentially problematic visibility of pedestrians near the front corners of these vehicles.

PRACTICAL APPLICATIONS

More research is needed to examine A-pillar blind zones by vehicle type. If it is found that LTVs have larger blind zones, automakers should consider ways to design the A-pillars of these vehicles to minimize blind zones while maintaining pillar strength. Doing this could improve pedestrian safety around these increasingly popular larger vehicles.

Traumatic Pediatric Fatalities: Are They Preventable?

INTRODUCTION

Trauma related injury remains the leading cause of mortality in pediatric patients, many of which are preventable. The goal of our study was to identify the mechanism of injury (MOI) in pediatric trauma-related fatalities and determine if these injuries were preventable to direct future injury prevention efforts within trauma programs.

METHODS

After IRB approval, a retrospective, single-institution review of pediatric (age ≤18) trauma fatalities from 2010 to 2019 was performed. MOI, use of protective devices, demographics, and whether the injury was preventable were collected. Patients were divided into five age cohorts, and frequencies and proportions were used to summarize data. Bivariate testing was done using Fisher's exact and Monte Carlo estimates for the exact test.

RESULTS

MOI was found to vary by age with non-accidental trauma found to be the most common cause of trauma related deaths in children <1 (88.5%) and 1-4 (33.3%). MVC was the most common MOI in children >5 y, with 68.4% in the 5-9, 34.4% in the 10-14, and 45.8% in the 15-18 age group. The majority of fatalities resulted from a preventable injury (P < 0.0001) in the younger children with a negative association as age increased: 92.3% <1, 53.3% in 1-4, 36.8% in 5-9, 46.9% in 10-14 and 48.6% in 15-18. Of the preventable injuries, non-accidental trauma was the most common MOI in children <5, while GSW was the most common MOI in children >10.

CONCLUSIONS

This study demonstrates many pediatric fatalities are the result of a preventable traumatic injury. This data can guide focused traumatic injury prevention efforts.

State-of-the-art review: preventing child and youth pedestrian motor vehicle collisions: critical issues and future directions

Aim

To undertake a comprehensive review of the best available evidence related to risk factors for child pedestrian motor vehicle collision (PMVC), as well as identification of established and emerging prevention strategies.

Methods

Articles on risk factors were identified through a search of English language publications listed in Medline, Embase, Transport, SafetyLit, Web of Science, CINHAL, Scopus and PsycINFO within the last 30 years (~1989 onwards).

Results

This state-of-the-art review uses the road safety Safe System approach as a new lens to examine three risk factor domains affecting child pedestrian safety (built environment, drivers and vehicles) and four cross-cutting critical issues (reliable collision and exposure data, evaluation of interventions, evidence-based policy and intersectoral collaboration).

Conclusions

Research conducted over the past 30 years has reported extensively on child PMVC risk factors. The challenge facing us now is how to move these findings into action and intervene to reduce the child PMVC injury and fatality rates worldwide.

Urban versus rural setting as a predictor of injury type and severity among pediatric pedestrians: using a database derived from state-wide crash data and hospital discharge data in Illinois

We obtained and linked data from the Illinois Department of Transportation and the Illinois Hospital Discharge Data System 2008 - 2015. We evaluated differences in demographic characteristics, injury severity and type among cases and examined associations among injury type, severity, and crash location. There were 11,303 injured pedestrians under 19 years of age and 46% matched to hospital data. Demographic characteristics were similar to unlinked cases. Among linked cases, fractures, traumatic brain injury, open wound or amputation, and internal organ injuries occurred more often in rural areas (p < 0.001), as were more severe injuries (p < 0.001). Mild injury and soft tissue injuries occurred more often in urban areas (p < 0.001). These data can inform targeted interventions for injury reduction. Preliminary investigations found that more severe injuries and specific injury types are more likely to occur in rural versus urban settings. Our combined database approach may be extended to other databases.

Hold the Phone! Cell Phone-Related Injuries in Children, Teens, and Young Adults Are On the Rise

We describe trends in cell phone-related injuries in patients 21 years of age and under presenting to United States Emergency Departments. We calculated age-adjusted rates of cell phone-related injury per 100 000 individuals using data from the National Electronic Injury Surveillance System (NEISS) database and United States Census Bureau. From 2002 to 2015, an estimated 38 063 patients 21 years old and younger sustained a cell phone-related injury. The overall rate of injuries for all ages increased from 17.1 injuries per 100 000 in 2002 to 138 injuries per 100 000 in 2015, an increase of over 700%. The incidence of cell phone-related injuries increased across all age groups, with children 2 years of age and under experiencing the highest single incidence rate of 159 injuries per 100 000 in 2014. These findings highlight an important and relatively under-reported pediatric safety issue. Anticipatory guidance and injury prevention plans should be updated accordingly.

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.

Supervision of young children in parking lots: Impact on child pedestrian safety

INTRODUCTION

Pedestrian injuries are a significant pediatric public health concern worldwide. Younger children are at particular risk for pedestrian injuries in parking lots, but there is limited research regarding children's pedestrian behaviors in parking lots.

METHOD

This study examined children's behaviors and safety risks in parking lots through unobtrusive and unannounced observation of 124 children ages 2-10 years and their adult supervisors as they crossed a parking lot from their parked vehicle into a community recreation center.

RESULTS

Adult supervision was inadequate: over 67% of children 10 years of age and younger were unsupervised in the parking lot at some point between the vehicle parking and the child entering into the building. Approximately 90% of all children were outside of arm's length of the accompanying adult at some point while in the parking lot. Additionally, children exited the vehicle prior to the adult in over 50% of observations. Age was associated with safety risk, with older children being unsupervised more often than younger ones.

CONCLUSIONS

Adult supervision of children in a parking lot setting was poor, creating significant safety risks. In addition, many children failed to follow basic pedestrian safety practices themselves, such as looking for moving cars. Injury prevention strategies should be implemented. Practical applications: As researchers gain better understanding about the safety risks for children in parking lots, interventions could target adult and child behaviors through improved supervision, altered perception of risk, and mandated behavioral guidelines for child behavior, such as how and when children exit vehicles in parking lots.

Children's mobility and environmental exposures in urban landscapes: A cross-sectional study of 10-11 year old Scottish children

Research into how the environment affects health and related behaviour is typically limited in at least two ways: it represents the environment to which people are exposed using fixed areal units, and, it focuses on one or two environmental characteristics only. This study developed a methodology for describing children's mobility and the complexity of their environmental exposure across a 1934 km2 study area, including urban, suburban and rural zones. It conceptualised and modelled this area as a landscape, comprised of spatially discrete amenities, infrastructure features, differing land covers/use and broader environmental contexts. The model used a 25 m2 grid system (∼3 million cells). For each cell, there was detailed built-environment information. We joined data for 100 10/11-year-old children who had worn GPS trackers to provide individual-level mobility information for one week during 2015/16 to our model. Using negative binomial regression, we explored which landscape features were associated with a child visiting that space and time spent there. We examined whether relationships between the features across our study area and children's use of the space differed by their sociodemographic characteristics. We found that children often used specific amenities outside their home neighbourhood, even if they were also available close to home. They spent more time in cells containing roads/transportation stops, food/drink retail (Incidence rate ratio (IRR):4.02, 95%CI 2.33 to 6.94), places of worship (IRR:5.98, 95%CI 3.33 to 10.72) and libraries (IRR:7.40, 95%CI 2.13 to 25.68), independently of proximity to home. This has importance for the optimal location of place-based health interventions. If we want to target children, we need to understand that using fixed neighbourhood boundaries may not be the best way to do it. The variations we found in time spent in certain areas by sex and socio-economic position also raise the possibility that interventions which ignore these differences may exacerbate inequalities.

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.

"Outta my way!" Individual and environmental correlates of interactions between pedestrians and vehicles during street crossings

Because pedestrian crash rates remain lower than other collision types, surrogate measures such as traffic interactions are now used in road safety research to complement crash history. Using naturalistic data collection, we sought to assess 1) the likelihood of occurrence of interactions between pedestrians and vehicles based on individual and crossing characteristics; and 2) differences in interaction characteristics between children, adult and senior pedestrians. Observations of pedestrian crossing behaviours (n=4687) were recorded at 278 crossings. For recorded interactions (n=843), information was collected to characterize the behaviours of involved parties. A mixed-effect logit regression model was performed to assess the factors associated with interactions. Chi-square tests evaluated differences between age groups and characteristics of observed interactions. Older adults were those more likely to be involved in an interaction event. Bicycle paths, different crossing surface material and one-way streets were significantly associated with fewer interactions with vehicles, while parked vehicles nearby and crossings on arterial roads were significantly associated with more interactions. Children and the elderly (80 years of age or more) did have distinct patterns of interaction, with more careful drivers/cyclists behaviours being observed towards children and lesser regulation compliance towards the elderly. Given the growing emphasis and adoption of active transportation in many cities, the number of interactions between pedestrians and vehicles during street crossings is likely to increase. Educating drivers and pedestrians to respect each other's space requires an understanding of where, between whom, and under what circumstances interactions occur. Such an approach can also help identify which engineering and enforcement programs are needed to ensure safe pedestrian crossings since interactions can be good markers of uncomfortable crossing situations that may deter walking and lead to more collisions.