The epidemiology and prevention of child pedestrian injury

doi:10.1016/0001-4575(90)90046-N

Accident Analysis & Prevention

Volume 22, Issue 4, August 1990, Pages 301-313

https://doi.org/10.1016/0001-4575(90)90046-N Get rights and content

Abstract

Of pedestrian injuries that occur every year, approximately 50,000, including 1300 fatalities, are experienced by children between the ages of 1 and 14 years. Despite the importance of the problem, the pedestrian safety issue is often neglected in reports on vehicular injuries. Children between the ages of five and nine years, boys, and children in lower socioeconomic class are at higher risk of pedestrian injury than other children. Childhood pedestrian injuries take place predominantly in residential locations close to home and frequently occur while the child is at play. The risk of pedestrian injury to children is higher than that of other age groups when adjusted for traffic exposure, and a variety of developmental limitations may account for this fact. In spite of these limitations, children undertake collision avoidance maneuvers far more often than drivers do. Accident analyses have identified 15 different accident types, each reflecting a unique combination of human and environmental factors. Among children, the most frequently observed accident type is the midblock dart-out. Programs to modify pedestrian behavior, driver behavior, and vehicle design have met with modest success. In the United States, the cultural and political environments have not been favorable to the injury prevention effort. Urban designers and traffic engineers in Europe have undertaken a variety of modifications of the physical environment, and some of these have been successful in preventing pedestrian injuries to children.

References (76)

B. Guyer et al.
Pedestrian injuries to children and youth
Pediatr. Clin. North Am.
(1985)
W. Haddon
A logical framework for categorizing highway safety phenomena and activity
J. Trauma
(1972)
R. Hart
Children's experience of place
J.T. Gantwoort
Pedestrian planning in the Netherlands
Voice of the Pedestrian
(1982)
National Cooperative Highway Research Program Synthesis of Highway Practice
Pedestrians and traffic control measures
NCHRP Project 20-5
(December 1987)
J.A. Rothengatter et al.
Evaluation of a pedestrian training programme for preschool children
OECD Road Research Programme, Seminar on Short-term and Area-wide Evaluation of Safety Measures. Amsterdam
(April 1982)
W.H. Yeaton et al.
Teaching pedestrian safety skills to young children: An analysis and one year follow-up
J. Appl. Behav. Anal.
(1978)
American Automobile Association
Pedestrian safety report: Special report on pedestrian deaths and injuries for ages 0 through 29
D. Appleyard
Livable streets
(1981)
S.J. Ashton
Vehicle design and pedestrian injuries

S.P. Baker et al.

Fatal pedestrian collisions—Driver negligence

Am. J. Public Health

(1974)

J.I. Barancik et al.

Motor vehicle trauma in northeastern Ohio. I: Incidence and outcome by age, sex, and road-use category

Am. J. Epidemiol.

(1986)

G.T. Bennett et al.

Road accidents in traditionally designed local authority estates

R.D. Blomberg et al.

Development of model regulations for pedestrian safety

(1974)

R.D. Blomberg et al.

Experimental field test of the model ice cream truck ordinance in Detroit

(1978)

R.D. Blomberg et al.

Identification and test of pedestrian safety messages for public education programs

(1975)

R.J. Brison et al.

Fatal pedestrian injuries to young children: A different pattern of injury

Am. J. Public Health

(1988)

S. Brower et al.

Outdoor recreation as a function of the urban housing environment

Environment and Behavior

(1974)

R.J. Bush

Statewide pedestrian study: Evaluation of thirty-one high pedestrian accident locations

M.H. Cameron

Nature and value of present pedestrian protection measures

Paper presented to Institute of Engineers meeting, Melbourne, Australia

(1967)

S.O. Gunnarson

Strategies for reduction of traffic risks through urban traffic planning

Güttinger, V.A. de Gebruikswaarde Van de Woonomgeving. Leiden: NIPG-TNO;...H.H. van der Molen

Child pedestrians' exposure, accidents and behavior

Accid. Anal. Prev.

(1981)

W. Haddon et al.

A controlled investigation of the characteristics of adult pedestrians fatally injured by motor vehicles in Manhattan

J. Chronic Dis.

(1961)

E.R. Huffman et al.

Children's estimates of vehicle approach times

Hum. Factors

(1980)

M. Hoque et al.

Pedestrian accidents: An examination by road class with special reference to accident cluster

Traffic Engineering + Control

(1986)

C.I. Howarth et al.

An analysis of road accidents involving child pedestrians

Ergonomics

(1974)

C.I. Howarth

Interactions between drivers and pedestrians: Some new approaches to pedestrian safety

C.M. Illingworth

227 road accidents to children

Acta Paediatr. Scand.

(1979)

B. Kahrmann

Area-wide traffic restraint measures: Analysis of accidents in Berlin-Charlottenburg

A. Katz et al.

An experimental study of driver and pedestrian interaction during the crossing conflict

Hum. Factors

(1975)

J.W. Kessler

Development of countermeasures to reduce pedestrian head injury

A.J. Chapman et al.

Children at play

A.J. Dedoyan et al.

Analysis of injuries sustained by pedestrians in urban traffic accidents

R.L. Duecker

(1981)

P. Ehrlich et al.

Effectiveness and efficiencies in pedestrian safety

(1982)

D.D. Embry et al.

Reducing the risk of pedestrian accidents to preschoolers by parent training and symbolic modeling for children: An experimental analysis in the natura

Federal Highway Administration

School trip safety and urban play areas

Federal Register

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Pedestrians are considered as one of the vulnerable road user groups. Among pedestrians of all ages, children are the most at risk. Previous studies have shown that children have inadequate knowledge of road safety and are unable to identify risks on road. Despite these limitations associated with children, society places the burden on them to protect themselves. However, to be able to adequately address child pedestrian safety issues there is the need to understand the factors that influence their crash involvement and severity of injury they sustain. To address this gap, this study performed a comprehensive analysis of historical crash data in Ghana to find holistic countermeasures for these crashes. The study used five years of child pedestrian (below 10 years) crash records obtained from the Building and Road Research Institute (BRRI) in Ghana. A temporal analysis of the data revealed that the highest number of the crashes coincide with when school-going children go to and close from school. A random parameter multinomial logit model was developed to identify crash variables that are significantly associated with child pedestrian crash outcomes. The estimation results revealed that children are likely to be killed in crashes when the driver is speeding and inattentive. Also, it was found that children walking along the road, crossing the road, and those in urban areas are more susceptible to incapacitating injury crashes. Male drivers accounted for 95.8% of child pedestrian crashes, and crashes involving male drivers are 7.8% more likely to be fatal.
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Pedestrian injuries are a leading cause of death among South African children, and young children residing in low-income communities are more at risk, due to various factors such as inadequate road infrastructure, exposure to traffic due to reliance on walking as a means of transport, and lack of supervision. This study used a cross-sectional, non-randomized self-report survey to assess pedestrian safety knowledge, road-crossing behaviour and pedestrian injuries of primary school children in selected low-income settings in Cape Town. The survey focused on three primary schools that had joined the Safe Kids Worldwide Model School Zone Project and was administered to 536 children aged 6–15 years, in their home language of isiXhosa. Descriptive and bivariate analyses as well as multivariate regression analyses were conducted to investigate potential predictor variables for pedestrian collision severity and unsafe road-crossing behaviour. Walking was the sole form of travel for 81% of the children, with a large proportion regularly walking unsupervised. Children who walk to or from school alone were younger and reported riskier road-crossing behaviour, although children who walk accompanied tended to have higher pedestrian collision severity. “Negligent Behaviour” related to road-crossing was significantly associated with higher pedestrian collision severity, with predictors of “Negligent Behaviour” including the lack of pedestrian safety knowledge and greater exposure to traffic in terms of time spent walking. More than half of the reported pedestrian collisions involved a bicycle, and older boys (10–15 years) were most at risk of experiencing a severe pedestrian injury. The findings substantiate emerging evidence that children in low-income settings are at greater risk for child pedestrian injury, and emphasise the need for evidence-based safety promotion and injury prevention interventions in these settings.
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It should be noted that Berthié et al. (2015) asked their respondents some questions regarding their prior crash involvement but were unable to establish any links to MW propensity. Analysis of crash data has found that a high proportion of crashes are reported on roads close to drivers’ homes (Abdalla et al., 1997; Malek et al., 1990), however to date these findings have not been matched with information about drivers’ exposure on these roads so again, links between familiarity and crash risk remain unclear. This research has established that MW is a complex and widespread issue during everyday driving.
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Child pedestrian injury poses a significant global public health challenge. This study examines relations between temperamental fear and children’s risky pedestrian behavior, utilizing mediation analytic strategies to study underlying mechanisms of the hypothesized relation.
As part of a larger study, 240 seven- and eight-year-old children completed 30 crossings in a virtual reality (VR) pedestrian environment. Three pedestrian behaviors were considered: start gap (lag after a traffic gap appears before child initiates crossing into the gap), time to contact (TTC; gap between avatar and the lead oncoming vehicle), and hits (collisions with vehicles in simulated crossings). Temperamental fear was measured by parent report.
Fearful children were more likely to be struck by virtual vehicles, and the relation between fear and risky pedestrian behaviors was mediated by start gap and TTC. Specifically, children who were temperamentally more fearful were more likely to hesitate before initiating crossing, which led to shorter gaps between themselves and the oncoming vehicle, hence causing them to be more likely to be hit by virtual vehicles. Gender interacted with fear, such that fearful girls were most likely to be hit.
Both temperamental fear and gender influenced the risk of child pedestrian injuries. Delayed entry into traffic and shorter gaps between children and oncoming vehicles may underlie this relation. Future research should explore how these factors might influence the effectiveness of prevention programs.
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Research on the safety of child pedestrians began in the mid-1970s (Reiss, 1975). Many studies have analyzed spatial and demographic patterns of child pedestrian injury, the ability of children to safely navigate the city, and the impacts of safety education programs (Appleyard, 1981; Malek et al., 1990; Mendoza et al., 2012; Schwebel et al., 2008; Southworth, 1990). Safe Routes to School programs emerged in Denmark in the 1970s to improve the safety of non-motorized travel (National Center for Safe Routes to School, 2013).
School transportation has been the subject of numerous federal and state policies since the early twentieth century–the Safe Routes to School program is the most recent example. However, few recent studies have thoroughly analyzed the risks and costs associated with different modes of transportation to school. Our descriptive study assessed the injury and fatality rates and related safety costs of different modes of school transportation using crash and exposure data from North Carolina, USA from 2005 to 2012. We found that riding with a teen driver is the most dangerous mode on a per trip basis with injury rates 20 times higher and fatality rates 90 times higher than school buses, which had the lowest injury rates. Non-motorized modes had per trip injury rates equivalent to school buses but per trip fatality rates were 15 times higher than for school buses. The economic costs of school travel-related injuries and fatalities for walking, biking, and teen drivers were substantially higher than other modes. This research has important policy implications because it quantified the risks of different school travel modes which allows policymakers to consider how safety investments can reduce risks. Decades of effort by schools, communities, and the government have made school buses a very safe mode and endeavored to reduce risks to teen drivers. This study highlighted the need for these same actors to reduce the risks of injury for walking and bicycling. As more improvements are made to infrastructure around schools, repeated studies of this type will allow practitioners to examine whether the improvements help mitigate the risks.
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The aim of this paper was to confront child anthropometry with three vehicle shapes to identify potential injuries on children when they are impacted by the front end of a car. In the Malek et al. (1990) classification, this study has to be considered as research that addresses countermeasures to prevent child pedestrian injuries during a crash. This work was divided into two steps.
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The epidemiology and prevention of child pedestrian injury

Abstract

Pediatr. Clin. North Am.

J. Trauma

Voice of the Pedestrian

NCHRP Project 20-5

OECD Road Research Programme, Seminar on Short-term and Area-wide Evaluation of Safety Measures. Amsterdam

J. Appl. Behav. Anal.

Pedestrian safety report: Special report on pedestrian deaths and injuries for ages 0 through 29

Livable streets

Vehicle design and pedestrian injuries

Fatal pedestrian collisions—Driver negligence

Am. J. Public Health

Motor vehicle trauma in northeastern Ohio. I: Incidence and outcome by age, sex, and road-use category

Am. J. Epidemiol.

Road accidents in traditionally designed local authority estates

Development of model regulations for pedestrian safety

Experimental field test of the model ice cream truck ordinance in Detroit

Identification and test of pedestrian safety messages for public education programs

Fatal pedestrian injuries to young children: A different pattern of injury

Am. J. Public Health

Outdoor recreation as a function of the urban housing environment

Environment and Behavior

Statewide pedestrian study: Evaluation of thirty-one high pedestrian accident locations

Nature and value of present pedestrian protection measures

Paper presented to Institute of Engineers meeting, Melbourne, Australia

Strategies for reduction of traffic risks through urban traffic planning

Child pedestrians' exposure, accidents and behavior

Accid. Anal. Prev.

A controlled investigation of the characteristics of adult pedestrians fatally injured by motor vehicles in Manhattan

J. Chronic Dis.

Children's estimates of vehicle approach times

Hum. Factors

Pedestrian accidents: An examination by road class with special reference to accident cluster

Traffic Engineering + Control

An analysis of road accidents involving child pedestrians

Ergonomics

Interactions between drivers and pedestrians: Some new approaches to pedestrian safety

227 road accidents to children

Acta Paediatr. Scand.

Area-wide traffic restraint measures: Analysis of accidents in Berlin-Charlottenburg

An experimental study of driver and pedestrian interaction during the crossing conflict

Hum. Factors

Development of countermeasures to reduce pedestrian head injury

Children at play

Analysis of injuries sustained by pedestrians in urban traffic accidents

Effectiveness and efficiencies in pedestrian safety

Reducing the risk of pedestrian accidents to preschoolers by parent training and symbolic modeling for children: An experimental analysis in the natura

School trip safety and urban play areas