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Using virtual reality to train children in safe street-crossing skills
  1. David C Schwebel1,
  2. Leslie A McClure2
  1. 1Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
  2. 2Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA
  1. Correspondence to Dr David C. Schwebel, Department of Psychology, University of Alabama at Birmingham, 1300 University Blvd, CH 415, Birmingham, Alabama 35294, USA; schwebel{at}


Background Pedestrian injuries are among the leading causes of morbidity and mortality in middle childhood. One limitation to existing pedestrian safety interventions is that they do not provide children with repeated practice needed to develop the complex perceptual and cognitive skills required for safe street crossing. Virtual reality offers training through repeated unsupervised practice without risk, automated feedback on success of crossings, adjustment of traffic to match children's skill and a fun, appealing environment for training.

Objective To test the efficacy of virtual reality to train child pedestrians in safe street crossing.

Setting Birmingham, Alabama, USA.

Methods A randomised controlled trial is underway with an expected sample of four groups of 60 children aged 7–8 years (total N=240). One group receives training in an interactive, immersive virtual pedestrian environment. A second receives pedestrian safety training via widely used video and computer strategies. The third group receives what is judged to be the most efficacious treatment currently available, individualised behavioural training at streetside locations. The fourth group serves as a no-contact control group. All participants are exposed to a range of field and laboratory-based measures of pedestrian skill during baseline and post-intervention visits, as well as during a 6-month follow-up assessment.

Outcome Measures Primary analyses will be conducted through linear mixed models testing change over time in the four intervention groups. Three pedestrian safety measures will serve as primary outcomes: temporal gap before initiating crossing, temporal gap remaining after crossing and attention to traffic while waiting to cross.

Clinical Trial Registration This study is registered at the US government website,, under the title ‘Using virtual reality to train children in pedestrian safety’, registration number NCT00850759.

  • Children
  • injury
  • pedestrian
  • public health
  • safety
  • street crossing
  • virtual reality

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  • Funding The project described was supported by award no R01HD058573 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Eunice Kennedy Shriver National Institute of Child Health and Human Development or the National Institutes of Health. Initial development of the virtual environment was supported by the UAB Injury Control Research Center at the University of Alabama at Birmingham through a grant from the National Centre for Injury Prevention and Control, Centers for Disease Control and Prevention, award R49/CE000191 and a cooperative agreement with the Federal Highway Administration, project no ICRC (1)/PL 106-346.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Institutional Review Board at the University of Alabama at Birmingham.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; not externally peer reviewed.