Issue 4 (11-19-01)
Safe Behavior and Prevention of Injuries
to Pedestrians and Bicyclists

In this issue we explore new insights on how the behavior of pedestrians, bicyclists, and drivers, affects their safety. We highlight recent research on the impact that parents, educators, and health professionals can have on teaching safe behaviors, gaps in current knowledge, and directions for the future.

	journal articles
	reports
	newspaper articles

Access Note: Many items cited in this issue of PBIC Currents have recently been published in journals that are available through academic libraries. To obtain and read these items, visit your community's college and university libraries, or use the interlibrary loan network through your local public library. Some readers may have access to electronic versions of journals through local library service systems. When links to full text and related resources are available, they accompany citations.

Journal Articles:

"Children's Attentional Skills and Road Behavior." G. Dunbar, R. Hill, and V. Lewis. Journal of Experimental Psychology: Applied. Vol. 7(3) September 2001 : 227-234.

Two skills necessary for safe pedestrian behavior, the ability to switch attention and the ability to concentrate, were studied. A sample group of children 4 to 10 years old were observed while they played a computer game that required players to switch attention. Concentration skills of were studied in a smaller group of these children. The smaller group was shown a cartoon video to distract them while they were given a complex task that required them to match familiar figures. This same group was also observed as they crossed roads. The findings of this observational study were that older children were able to switch their attention faster and were less easily distracted, children who were better at switching their attention were more aware of traffic when they were about to cross roads, and children who could maintain their concentration in the face of distractions were more careful as they crossed roads. The authors encourage those who design programs to teach road safety to children to take into account the development of attentional skills.

"Factors Associated with Parental Safe Road Behaviour as a Pedestrian with Young Children in Metropolitan New South Wales, Australia." L.T. Lam. Accident Analysis and Prevention.Vol 33(2): March 2001; 203-210.

Safe or unsafe behavior of parents affects their behavior with their children. A telephone survey interviewed parents with children between 5 and 12 years old who live in the metropolitan area of Sydney, to investigate factors associated with with safe road behavior. Parents who believed that the road environment is hazardous acted with greater caution as pedestrians while with their children. Conversely, the survey indicated no association between parents' knowledge of road rules and safe road behavior. The results of this study suggest that safe road behavior of parents is an influential factor in traffic safety programs for children.

"Partnering for Injury Prevention: Evaluation of a Curriculum-based Intervention Program among Elementary School Children." L.S. Gresham, D.L. Zirkle, S. Tolchin, C. Jones, C. A. Maroufi, and J. Miranda. Journal of Pediatric Nursing. 16(2):79-87, April 2001.

The usefulness of Think First for Kids (TFFK), an injury prevention program for children grades 1, 2, and 3, was evaluated in two sets of schools, those where the program was taught (intervention schools) and those where it was not (control schools). The study showed that children often lack basic knowledge regarding safety and do not recognize unsafe behaviors that increase their risk for injury. Children in the intervention and control schools were tested to evaluate whether they learned safe behaviors, and test results were compared between the two sets of schools. Self-reported, high-risk behaviors decreased children from schools where the program was taught as compared to those children who received no special safety education. Although African American and Hispanic children had the lowest test scores at the beginning of the program, they showed the largest improvement in posttest scores. The TFFK injury prevention program addresses the leading causes of trauma among children including sports, motor vehicle crashes, falls, drowning, and pedestrian injuries.

Related Web site: The National Injury Prevention Foundation's Think First web site: http://www.thinkfirst.org/home.html

"Stop, Look, Listen, and Think? What Young Children Really Do when Crossing the Road." M. S. Zeedyk, L. Wallace, and L. Spry. Accident Analysis and Prevention. Vol 34(1): January 2002. P. 43-50.

This observational study was designed to gather basic information about children's behavior in realistic traffic situations, in order to identify the important elements for inclusion in educational programs. Children 5 and 6 years old took part in a `treasure trail' activity in which they were confronted with two road crossings, one at a T-junction with a moving car and the other between parked cars. Their performance was videotaped and coded for safe behavior, such as stopping at the curb, looking for traffic, direction of gaze, and the way they crossed the road - whether they walked or ran. Results revealed that young children have extremely poor safety skill performance. Sixty percent of the children failed to stop before proceeding from the curb onto the road. Less than half of the children looked for oncoming traffic. When they did look, they were as likely to look in the inappropriate direction as in the appropriate direction. Because this study was based on controlled naturalistic tasks and detailed observational methods, it builds on earlier studies that only estimated rates of children's behaviors.

"The Influence of Status on Pedestrians' Failure to Observe a Road-Safety Rule". N. Gueguen and N. Pichot. Journal of Social Psychology. June 2001; Vol. 141(3): 413-415.

In a city environment with heavy automobile and pedestrian traffic, several thousand pedestrians were observed to study whether apparent social status would affect their compliance with pedestrian signals. An associate of the authors, who was dressed to appear either to be a person of high, low, or intermediate social status, routinely crossed the street against the signal. The authors found that the number of offenses committed by pedestrians increased significantly when the confederate was dressed as a high-status person rather than when clothes suggesting a low or intermediate status were worn.

"Use of Alcohol as a Risk Factor for Bicycling Injury." G. Li, S. P. Baker, J.E. Smialek, and C.A.Soderstrom. JAMA: Journal of the American Medical Association. Vol 285(7): February 2001; 893-896.

The risk of injury among bicycle riders after drinking alcohol was assessed from a review of medical records of bicyclists who had been injured in crashes. Elevated blood alcohol concentration levels (BACs) were found in about one-third of fatally injured bicyclists aged 15 years or older. To collect data for a control group, the researchers conducted roadside interviews with bicyclists using hand-held devices that detected breath alcohol.

"Pedestrian Fatalities and Alcohol." M. Oestroem and A. Eriksson. Accident Analysis and Prevention. Vol 33(2): March 2001 : 173-180.

Autopsy and police reports for nearly three hundred fatal pedestrian crashes in Sweden were studied to examine patterns and rates of alcohol consumption. The age of the victims was from 1 to 95 years. Nineteen percent of these fatalities had detectable blood alcohol levels. Men tested positive more often for blood alcohol than women. Victims who had been drinking alcohol tended to be younger, and were more likely to be involved in fatal crashes during weekends and at night.

"Slips and Falls in Stores and Malls: Implications for Community-Based Injury Prevention." D. Hantula, J. Bragger, L. DeNicolis and A. K. Rajala.
Journal of Prevention and Intervention in the Community. Vol 22(1): 2001; 67-79.

Grocery stores and shopping malls are an integral part of the pedestrian environment. Analysis of slip, trip, and fall accidents in these places showed that most occurred inside buildings, and resulted from spilled water, liquid or food items on the floor. Design problems were least likely to be the cause of accidents, while facilities with poor housekeeping and inspection problems were more likely to have conditions where walking was more hazardous. Recommendations for injury prevention are offered that focus on management intervention to reduce hazards.

"Trends and Subgroup Differences in Transportation-related Injury Risk and Safety Behaviors among High School Students, 1991-1997." S.A. Everett, R.A. Shults, L.C. Barrios, J.J.Sacks, R. Lowry, and J.Oeltmann. Journal of Adolescent Health. Vol 28(3): March 2001; 228-234.

Using data from the national Youth Risk Behavior Surveys (YRBS), researchers from the U.S. Centers for Disease Control and Prevention (CDC) examined national trends in transportation-related injury risks and safety behaviors among US high school students. They looked at such risky behaviors as riding with a driver who had been drinking, driving after drinking, and using seat belts, bicycle helmets, and motorcycle helmets. The YRBS is a self-administered, anonymous survey that uses a national probability sample of ninth through twelfth grade students in public and private schools in the United States. The percentages of students who rode with a driver who had been drinking, drove after drinking alcohol, always wore seat belts, and always wore a motorcycle helmet when riding a motorcycle remained stable between the years 1991 and 1997, . Conclusions made from the analysis showed that many young people's unsafe behavior exposes them to unnecessary risks . Injury prevention strategies that specifically target changing risky behavior in young people need to be developed to reduce the number of motor vehicle- and bicycle-related crash injuries and fatalities among this age group.

The Youth Risk Behavior Surveys and the Youth Risk Behavior Surveillance System are an ongoing initiative of the CDC's National Center for Injury Prevention and Control. For more information, visit this web site: http://www.cdc.gov/nccdphp/dash/yrbs/index.htm

"Associations between Adult and Child Bicycle Helmet Use." J.G. Twomey, M.C. Bevis, and C.A. McGibbon. MCN, American Journal of Maternal/Child Nursing. 26(5):272-7, September-October 2001.

This observational study examined use and correct use of bicycle helmets in child and adult bicycle riders who rode in groups on a recreational bicycle path. Two independent observers noted all riders in groups that included both adults and children, as to whether they were wearing helmets or not. Those who wore helmets were then rated as to whether they wore them properly or improperly. Two-thirds of the children who were observed wore helmets, but less than one-half wore them properly. One third of the adults wore helmets, and one-half of those wore them properly. The authors encourage primary care nurses who work with families to encourage them to wear helmets when riding bicycles, and also to teach bicycle riders how to wear their helmets correctly.

"Surgeons and Injury Prevention: What You Don't Know Can Hurt You! " M.M. Knudson, M.J. Vassar, E.M. Straus, J.S. Hammond, and S.D. Campbell. Journal of the American College of Surgeons. 193(2):119-24, August 2001.

The most effective treatment for traumatic injuries is to prevent them from occurring. Currently, few surgeons receive any formal training in control and prevention of injuries. To test the knowledge of basic injury prevention principles among practicing trauma care surgeons and nurses, and identify areas for curriculum development for practicing surgeons, the American College of Surgeons(ACS) Committee on Trauma surveyed surgeons who attended professional meetings over a two year period. A specialized touch-screen computer was displayed at four different surgery and trauma meetings, including the ACS Clinical Congress. Those who participated were tested for their knowledge of trauma epidemiology, bicycle helmet effectiveness, child safety seat usage, and other injury-related subjects. The authors concluded that the majority of practicing surgeons and nurses, including those working at trauma centers, are unaware of the basic concepts of injury prevention.

The American College of Surgeons maintains a web site with injury prevention resources for physicians, which includes position statements, slide shows, and a list of suggested readings. Some Spanish-language resources are available. To visit this site, go to: http://www.facs.org/dept/trauma/injmenu.html

"Bicycle-Related Injuries." M.J. Thompson and F.P.Rivara. American Family Physician. 63(10):2007-14. May 15, 2001. Full text of this article is available from the American Academy of Family Physicians: http://www.aafp.org/afp/20010515/2007.pdf

Bicycle riding is a popular recreation for people of all ages, and bicycle riders are susceptible to significant injuries. This article reviews recently published studies that examine the nature and causes of bicycling injuries, and offers guidance to physicians who treat injured bicycle riders on how to reduce their patients' risk of further injury. Some highlights follow. Most injuries occur in males and are associated with riding at high speed. Most serious injuries and fatalities result from collisions with motor vehicles. Although superficial soft tissue injuries and musculoskeletal trauma are the most common injuries, head injuries are responsible for most fatalities and long-term disabilities. Overuse injuries may contribute to a variety of musculoskeletal complaints, compression neuropathies, perineal and genital complaints. Physicians treating such patients should consider medical factors, as well as suggest adjusting various components of the bicycle, such as the seat height and handlebars. Encouraging bicycle riders to wear helmets is key to preventing injuries. Bicyclists who wear protective clothing and equipment, and who actively practice safe behaviors while cycling reduce their risk of injury. Accompanying this article is a patient information handout on bicycle safety prepared by the authors for health practitioners. This handout may be downloaded separately from the article. Access to both the article and the handout is available at: http://www.aafp.org/afp/20010515/2007.html

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Reports:

Child Development and the Aims of Road Safety Education. London : United Kingdom Department of Transport, Local Government and the Regions, 2000. Full text at: http://www.roads.dtlr.gov.uk/roadsafety/aims/index.htm

In the United Kingdom, the Child Development Research Programme of the Department of Transport, Local Government and the Regions (DTLR) works to to provide a better understanding of how children learn, develop and use the skills needed to cope as pedestrians in traffic. In this report, the authors reexamine what it is to be a pedestrian, paying particular attention to the skills and abilities that underlie proficient traffic behavior. Their focus is on one of the central aims of road safety education - to teach children skills to enable them to safely navigate as pedestrians in traffic. The DTLR has developed other resources to teach safe traffic skills. To explore these, visit their main web site at this link: http://www.think.dtlr.gov.uk/hedgehogs/index.htm

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"AAA Awards Recognize Lifesaving School Patrols." Candace Purdom. REFRIGERATOR DOOR Column. Chicago Tribune. November 4, 2001.

Children who serve as members of school safety patrols perform heroic acts of lifesaving every year. To recognize these acts of courage, the AAA School Safety Patrol Lifesaving Medal program was established in 1949. More than 350 boys and girls from 31 states and Washington, D.C., have earned the honor. According to the AAA, many famous Americans have been safety patrol members, including former Presidents Jimmy Carter and Bill Clinton, 21 astronauts and six Olympic gold medalists.

A national review board representing education, law enforcement and safety selects each year's recipients from the candidates nominated. An awards ceremony in Washington, D.C., is held each May. This past May, three youngsters who acted quickly to prevent tragedies were honored. The AAA is once again on the lookout for acts of school patrol bravery. Nominations may be made by anyone who witnesses, or has reliable knowledge of, a patrol member's lifesaving act. Submissions for the current school year are due by February 2002.

To request a nomination form, contact your state AAA Motor Club at 800-AAA-HELP.