Child pedestrian safety: Parental supervision, modeling behaviors, and beliefs about child pedestrian competence

Pedestrian injuries are a significant health risk to children, particularly those 5–9 years of age. Surprisingly, few studies have explored parent-related factors that may moderate this risk. The present study used naturalistic observations of parent–child pairs crossing at uncontrolled intersections and a short interview to examine parental supervision of children during crossings, modeling of safe-crossing behaviors, beliefs about how children come to cross streets safely, and whether child attributes (age, sex) relate to parental practices and beliefs. Results revealed that parents more closely supervised younger than older children, they modeled safer crossing practices for sons more than daughters, particularly younger sons, and although over half the sample believed children need to be explicitly taught how to cross safely, few actually provided any instruction when crossing with their children. Providing parents both with guidelines for how to accurately appraise their child's readiness for crossing independently and with information about best practices for teaching children how to cross safely may facilitate parents’ implementing these practices, particularly if this is coupled with public advocacy highlighting the important role they could play to reduce the risk of child pedestrian injury.     

Relationship of parent driving records to the driving records of their children

Many studies have shown that young driver crash rates can be influenced by such factors as lifestyle characteristics and licensing systems. However, the influence of parents on their teenage children's crash and violation rates has not received much attention. The present study used data from the North Carolina driver history file to match the crash and violation records of young drivers between the ages of 18 and 21 with those of their parents. Results indicate that children's driving records in the first few years of licensure are related to the driving records of their parents. Children whose parents had three or more crashes on their record were 22% more likely to have had at least one crash compared with children whose parents had no crashes. Likewise, children whose parents had three or more violations were 38% more likely to have had a violation compared with children whose parents had none. Logistic regression models showed that these relationships held when controlling for household type and child gender.     

Paediatric slow-speed non-traffic fatalities: Victoria, Australia, 1985–1995

An important group of fatal incidents are slow-speed pedestrian non-traffic incidents to children, which account for 14% of accidental deaths from all causes in Victorian children under 5 years of age between 1985 and 1995, and 12% of pedestrian deaths of all ages. In Victoria, Australia, the database of the state Consultative Council on Obstetric and Paediatric Morbidity and Mortality was utilised to identify paediatric slow-speed pedestrian non-traffic-accident deaths in the local population. Additional data relating to the car and its driver, the child, and the circumstances of the incident were abstracted from records kept by the State Coroner and the Victorian compulsory third party traffic injury insurance organisation. Twenty eight Victorian children were identified who had died in one of three types of incident (driverless cars, child interacting with the vehicle and driver, and drivers who were unaware of the child's proximity). These incidents were more common in rural areas compared with urban, usually occurring at the child's home. The child was with or near an adult on all occasions. The vehicle was usually being driven by a relative, and was reversing in a higher proportion of ‘unaware’ incidents compared with the ‘interactive’ type. The association of ‘off-road’ family vehicles and trucks with these incidents appears to be increasing, especially in recent years. These findings suggest some countermeasures, including the separation of vehicle driveways from children's play areas, and object vicinity ultrasonic warning devices for vehicles.     

The epidemiology and prevention of child pedestrian injury

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.     

Factors influencing premature graduation from the use of child restraints in Japan

This study examined the association of child passenger restraint use by younger and older children taking into account situational factors and driver/child passenger characteristics. The Japanese national traffic accident data pertaining to children injured in rear-end collisions where the drivers were not-at-fault was analyzed, while applying the quasi-induced exposure method. Multivariate logistic regression analyses were conducted to examine the adjusted effects of predictors for proper restraint use by 0-5, 6-9, and 10-12-year-old children. Unbelted drivers, child's seating position, the number of total occupants, and the child's age were significantly associated with restraint use by both younger and older children. Riding in the rear seats was strongly associated with older SB-age children not being properly restrained, suggesting a link between the lack of booster seat-use requirements and the generally low restraint use rate in rear seats as well as the premature graduation from CRS use in general. The results were discussed in light of other international findings in this field.     

Factors associated with parental safe road behaviour as a pedestrian with young children in metropolitan New South Wales, Australia

A cross-sectional population-based randomised telephone survey of parents with children aged between 5 and 12 years was conducted to investigate factors associated with safe road behaviour of parents as pedestrians with their young children in Sydney metropolitan and near by cities in New South Wales, Australia. Parental perception of the road environment as hazardous associated significantly with their safe road behaviour as pedestrian while with their children. This held true even after adjusting for the non-English speaking background and the age of the child. Knowledge of road rules, on the other hand, was not associated with parental safe road behaviour. The results of this study suggested that parental safe road behaviour require much attention in future research and in programme development. The perception of the road environment is a very important factor in motivating safe road behaviour. This should be taken into consideration in designing road safety campaigns.     

A longitudinal study of the effectiveness of a multi-media intervention on parents’ knowledge and use of vehicle safety systems for children

Motor-vehicle crashes are the leading cause of death and serious injury for children under the age of 14 in Canada and in the United States despite mandatory use of vehicle restraints since 1977. Using a pre- and post-test design, the present study tests the effectiveness of a multi-media intervention study on parents’ knowledge of car safety seat use for children (0-12 years). The sample included 201 parents from four Ontario cities. Results indicate that parents’ knowledge of when to accurately and safely transition a child to the appropriate car safety seat based on child's age, weight and height was retained at the 1 year post-test for children 4-8 years of age. The rates of correct use of safety seats significantly increased 1 year following the intervention program. Other factors that influenced parent's knowledge included being a parent versus non-parents, gender, income, education, sources of information, and regional location. The results of this study can help guide the development and implementation of future intervention programs and injury prevention policy.     

Results of a randomized controlled trial assessing the efficacy of the Supervising for Home Safety program: Impact on mothers’ supervision practices

Unintentional injury constitutes a major health risk for young children, with many injuries occurring in the home. Although active supervision by parents has been shown to be effective to prevent injuries, evidence indicates that parents do not consistently apply this strategy. To address this issue, a randomized controlled trial was conducted to evaluate the impact of the Supervising for Home Safety program on parent supervision practices in the home and when unobtrusively observed in a naturalistic laboratory setting. Using a participant-event monitoring procedure, parents of children aged 2 through 5 years completed supervision recording sheets weekly both before and after exposure to the intervention program; Control parents completed the same measures but received a program focusing on child nutrition and active lifestyles. Unobtrusive video recordings of parent supervision of their child in a room containing contrived hazards also were taken pre- and post-intervention. Results indicated that groups did not differ in demographic characteristics. Comparisons of post- with pre-intervention diary reported home supervision practices revealed a significant decrease in time that children were unsupervised, an increase in in-view supervision, and an increase in level of supervision when children were out of view, with all changes found only for the Intervention group. Similarly, only parents in the Intervention group showed a significant increase in attention to the child in the contrived hazards context, with these differences evident immediately after and 3 months after exposure to the intervention. These results provide the first evidence that an intervention program can positively impact caregiver supervision.     

Recognition of home injury risks by novice parents of toddlers

Objective

Unintentional injury in the home is a leading cause of death for toddlers. The majority of injuries occur at home; parents play a significant role in injury prevention. Health-related behavior change theory suggests that behavior change is only possible if individuals (a) recognize the problem, and (b) believe they are vulnerable. This study examined these characteristics among novice parents of toddlers by investigating how well parents recognize hazards in the home and whether they believe their toddlers are vulnerable to those hazards.

Methods

Three types of participants were recruited: novice parents of toddlers ages 12-36 months, daycare employees, and pediatric healthcare workers. All participants were examined three rooms simulating a typical toddler's bedroom, a living room, and a bathroom. Participants marked any hazards they recognized with stickers. Parents completed the hazard identification task twice, once identifying hazards for all toddlers and another time identifying hazards for their child.

Results

Participants identified less than half the hazards present in the simulated rooms; parents identified more hazards than comparison groups. Parents identified significantly fewer hazards for their own child than they identified for other children.

Discussion

Although parents identified more hazards than the professionals, they failed to identify a large portion of hazards and they perceived their own children to have less vulnerability than toddlers more broadly. Results indicate that education about toddler's vulnerability to injury in the home, as well as instructing parents about what situations are hazardous, might be considered during development of toddler home injury prevention programs.     

Childhood pedestrian injury: a pilot study concerning etiology

For U.S. children of preschool and school age, fatal pedestrian injury is more common than fatal passenger injury, but there is no agreement on preventive approaches and their efficacy. Development of preventive measures requires understanding of how and why such injuries occur, which in turn requires better methods to sort out the many factors which appear to contribute to the problem. In an attempt to develop the broadest possible picture of the dynamics of child pedestrian injury, a multidisciplinary process was developed to collect and interpret medical, traffic, social, psychological and behavioral information concerning specific injury events. In a pilot study, the process was used to study six pedestrian injuries. The pilot study indicated that: the multidisciplinary approach identified possible etiologic factors missed without it; this approach requires the availability of high quality medical information and police accident records; biological, psychological, and social characteristics of victims, victim families and communities appear to affect the occurrence of child pedestrian injuries; and, such victim factors must be considered in development of countermeasures. It is concluded that the technique of multidisciplinary analysis merits further application as a productive way to generate quantitatively testable hypotheses concerning childhood pedestrian injury causality and potential countermeasures.     

Presence and use of stair gates in homes with toddlers (11-18 months old)

BACKGROUND: The aim of this study was to assess demographic correlates of the presence and use of stair gates in homes with toddlers. METHODS: In 2004, self-administered questionnaires were mailed to 2470 parents with toddlers living in both urban and rural areas (response rate 70.1%). The questionnaires were sent by the youth healthcare providers that the parents visited regarding their toddler. RESULTS: In total, 83% of the parents reported to have at least one stair gate installed; however, 50% of these parents reported that they did not always close the stair gate. Households with a non-Dutch ethnic mother, one child, a female child, a young child or a child who cannot crawl, were less likely to have a stair gate. Households with one child, a toddler who cannot walk, and a mother with a higher educational level were less likely to use the gate adequately. CONCLUSIONS: This study shows that parents of toddlers often report to have a stair gate; however, in homes with a gate the parents do not necessarily use the gate adequately. Different demographic characteristics were shown to be correlated with both having a stair gate and the use of a stair gate.     

Near miss and minor injury information--can it be used to plan and evaluate injury prevention programmes?

AIM: To assess the usefulness of collecting information on near miss and minor injuries for use in planning and evaluating injury prevention programmes for children aged under 5 years in the home environment. METHOD: The research was set within the context of a controlled intervention study based in 36 general practices across Nottingham. All parents of children aged between 3 and 12 months who had completed the intervention study questionnaire (n = 1594) were used as the sampling frame for the diary study. A diary, developed specifically for the main intervention study, was administered to a systematically assigned sample of 434 parents. Information provided by the Home Accident Surveillance System on 252 randomly selected children, of the same age and sex, who had attended an accident and emergency department, was used to compare the circumstances surrounding near miss and minor injuries with those of medically attended injuries. The children whose parents had completed a diary were followed over a two year time period. The children who had had a medically attended injury were identified from a search of the child's general practice records and the Queens Medical Centre accident and emergency records. The definition of a near miss used in the study was: A near miss incident is something your child does or that happened to your child which could have resulted in him/her being hurt, but fortunately it did not. RESULTS: Overall two hundred and thirty one (53%) diaries were completed and returned. Three hundred and fifty incidents were recorded of which 207 were near misses and 143 minor injuries. The circumstances surrounding near miss and minor injuries, although not identical when compared to medically attended injuries, were very similar. The relationship between the occurrence of near miss, minor injuries and future medically attended injuries appeared weak, for all categories the negative predictive value was higher than the positive predictive value. CONCLUSION: Although the circumstances surrounding all the incident categories were similar, the numbers were too small to see whether specific injury mechanisms predict future injuries of the same type. It appeared that near miss and minor injuries are of limited use in predicting medically attended injuries, however this hypothesis needs to be tested on a much larger sample.     

Factors associated with the premature graduation of children into seatbelts

This study investigated the factors associated with the premature graduation into seatbelts for Australian children aged 4-11 years. From 699 child restraint use questionnaires, 195 children were identified as meeting the booster seat height-weight criteria (height: 100-145 cm and weight: 14-26 kg). Of these children, 44% were correctly traveling in a booster seat, while 56% had been moved prematurely into a seatbelt. A multivariable logistic regression model showed that there were a number of key predictors associated with the premature graduation to seatbelts. For example, children who were moved prematurely into a seatbelt were more likely to be older, have other children travelling in the vehicle and have younger parents compared to children appropriately restrained in a booster seat. In addition, there was a significant interaction between vehicle type and parent's household income. Based on the findings of this study, a number of recommendations are made for strategies to enhance appropriate restraint use for this age group, as well as for future research.     

Unsafe storage of poisons in homes with toddlers

BACKGROUND: The objective of this project was to assess the current nature and level of preventive actions that parents take to avoid unintentional poisoning among toddlers (11-18 months old). METHODS: In 2004, we conducted a cross-sectional observational survey with self-administered questionnaires among parents with toddlers (n=1,722). Data were obtained on storage locations of medicines and cleaning products and supervision of children. RESULTS: Overall, 50.1% of the toddlers were exposed to unsafe storage of possible poisonous products in the home. Parents were more likely to store medicines safely than cleaning products, and products were most often stored unsafely in the kitchen, where children were left unattended most often (69%). Households with one child were associated with unsafe storage of both medicines and cleaning products. Lower educational level of the mother and unemployment of the mother were both associated with safe storage of medicines. Mother's ethnicity, the child's ability to walk, and the education level of the father were associated with storage of cleaning products. CONCLUSIONS: The results of this study are an important first step for the development of effective interventions to reduce unintentional poisoning in toddlers' homes.     

Characteristics of child safety seat users

Direct observation of child restraint use was combined with interviews and mail questionnaires to measure prevalence of various child restraint practices and factors related to use of child safety seats and seat belts for children under the age of four. Trained observers assessed multiple dimensions of child restraint practices for a sample of motorists entering fast-food parking lots in Michigan. On-site interviews and follow-up questionnaires measured sociodemographic, attitudinal, belief, and behavioral characteristics related to restraint use. Ninety-two percent of infants under age 1 and 55% of children age 1 to 3 were traveling in a child safety seat. Public support for the mandatory child restraint law was very high--9 out of 10 believed it should be strictly enforced. Child restraint use was lower than average among motorists who: (1) had low family incomes, (2) were not currently married, (3) were of nonwhite ethnic backgrounds, and (4) were over the age of 40. A shift in social norms appears to have occurred in recent years, such that restraint of young children traveling in cars is now socially expected behavior. Recommendations include: (1) continuing educational efforts to increase knowledge of mandatory child restraint use laws, and (2) increased enforcement of mandatory child restraint use laws.     

交通噪声对儿童影响的研究综述

作为城市最普遍存在的环境噪声,交通噪声对儿童的健康成长会产生负面影响。通过对13个国家67项实证研究的文献分析,发现交通噪声对儿童影响主要表现在以下三个方面:在身体健康方面,交通噪声影响儿童的听觉、睡眠和心率血压等;在认知能力方面,影响儿童的阅读表现、记忆力、数学能力、注意力等,但目前对各种认知能力的研究深入程度不一;在心理健康方面,交通噪声引发儿童烦恼、心理压力和行为问题。通过对文献的梳理与总结,发现目前的研究存在如下问题:评价指标各异,难以形成统一结论;相关因素众多,混淆变量干扰研究结论;研究范式不同,研究结论存在差异。基于问题提出相关对策:构建标准化指标体系与规范化研究范式;深入运用社会学方法,明确社会环境因素对儿童的影响;开展交通噪声与交通空气污染综合影响的研究,厘清后者对结论的混淆。     

Protective actions in the late phase--intervention criteria and decision-making

Major countermeasures in the late phase of a nuclear or radiological accident where long-lived radionuclides have been dispersed in the environment are relocation/resettlement, foodstuff restrictions, agricultural countermeasures and clean-up of contaminated areas. There has essentially been a broad acceptance internationally of the principles for their introduction, but it has not been possible to reach an agreement for the purpose of defining a net benefit based upon the exact weighting to be attached to each of the attributes influencing the decision on intervention, e.g. socio-psychological attributes. Optimisation of protection, i.e. maximising the net benefit, is not a question of developing radiation protection philosophy to fully include socio-psychological factors but rather to include these factors--in parallel with the radiological protection factors--in cooperation between radiation protection experts and e.g. experts in social and psychological sciences under the responsibility of the decision-maker, who will take the final decision on the introduction of long-term countermeasures.     

Evaluation of a child passenger safety class in increasing parental knowledge

Background

Child passenger restraint systems have been found to greatly reduce the risk of injury and death among child passengers. However, nearly half of the children who died in 2009 as a result of motor vehicle crashes were completely unrestrained. Our global hypothesis is that parents and other caregivers failed to restrain children due to a lack of child passenger seat education and practice. In this report, we postulate that a car seat class will improve the basic understanding of child passenger safety. The objective of the study was to evaluate the effectiveness of a car seat class in increasing parental knowledge about child passenger safety.

Methods

Car seat classes were held at a Level 1 pediatric trauma center every other Tuesday for ten months. The curriculum consisted of: child passenger safety laws discussion, a 21-min video on the use of child safety seats followed by a 15-min discussion about the video, 15 min of discussing the different types of car seats, and hands-on training on how to properly install and use child restraints. Free car seats were provided to eligible parents. The pre-test was administered at the beginning of class and the post-test at the end of the class. McNemar's test and a paired t-test were used to compare pre- and post-test scores. Test scores were also stratified by language spoken.

Results

Forty-four classes were held and a total of 491 parents/caregivers attended the classes. An increase in knowledge was found for all survey questions. Mean knowledge score for the post-test was 3.10 points higher compared to the mean knowledge score from the pre-test. Mean difference in knowledge scores for English-speaking participants were higher than Spanish-speaking participants.

Conclusion

Lack of knowledge and low risk perception have frequently been cited as barriers for the use of child passenger restraints. Our intervention attempted to eliminate these barriers. We found that this intervention was effective at increasing parental knowledge about child passenger safety. The results of this study may be used to design and implement future interventions in multicultural settings.     

Validation of virtual reality as a tool to understand and prevent child pedestrian injury

In recent years, virtual reality has emerged as an innovative tool for health-related education and training. Among the many benefits of virtual reality is the opportunity for novice users to engage unsupervised in a safe environment when the real environment might be dangerous. Virtual environments are only useful for health-related research, however, if behavior in the virtual world validly matches behavior in the real world. This study was designed to test the validity of an immersive, interactive virtual pedestrian environment. A sample of 102 children and 74 adults was recruited to complete simulated road-crossings in both the virtual environment and the identical real environment. In both the child and adult samples, construct validity was demonstrated via significant correlations between behavior in the virtual and real worlds. Results also indicate construct validity through developmental differences in behavior; convergent validity by showing correlations between parent-reported child temperament and behavior in the virtual world; internal reliability of various measures of pedestrian safety in the virtual world; and face validity, as measured by users' self-reported perception of realism in the virtual world. We discuss issues of generalizability to other virtual environments, and the implications for application of virtual reality to understanding and preventing pediatric pedestrian injuries.     

Psychosocial factors related to parental restraint of pre-school children in motor vehicles

While the use of safety restraints effectively reduces the risk of death or injury in accidents, many children still travel unrestrained in motor vehicles. Compulsory seat belt legislation in Australia increased rates of adult use dramatically, but did not have the same impact with children. In order to understand why levels of children's restraint use remain low, it is necessary to investigate parental factors related to use and non-use of restraints. This study assessed the rates of safety restraint use of parents and their pre-school children, and the sociodemographic, attitudinal and belief characteristics of parents which relate to children's restraint use, using the Health Belief Model as a basis for investigation. Restraint use for adults was substantially higher than for pre-school children. Children were more likely to be restrained if their parents were wearing seat belts, were married, were of high socioeconomic status, did not smoke, engaged in certain other preventive health behaviors on their children's behalf, traveled longer distances to pre-school and provided child seats for their children. In terms of the Health Belief Model, parents of restrained and unrestrained children differed in their evaluation of the "costs" and "benefits" of using restraints for their children, and in health locus of control. Parents of unrestrained children perceived the "costs" of restraint use, in terms of nuisance value, installation difficulty and financial cost, to be high. They were also less likely to believe that they could play a significant role in preventing injury to their children. Implications of these findings for safety restraint campaigns are discussed.