Benjamin K. Barton

Systematic Review and Meta-Analysis of Behavioral Interventions to Improve Child Pedestrian Safety

OBJECTIVE Pedestrian injuries represent a pediatric public health challenge. This systematic review/meta-analysis evaluated behavioral interventions to teach children pedestrian safety. METHODS Multiple strategies derived eligible manuscripts (published before April 1, 2013, randomized design, evaluated behavioral child pedestrian safety interventions). Screening 1,951 abstracts yielded 125 full-text retrievals. 25 were retained for data extraction, and 6 were later omitted due to insufficient data. In all, 19 articles reporting 25 studies were included. Risk of bias and quality of evidence were assessed. RESULTS Behavioral interventions generally improve childrens pedestrian safety, both immediately after training and at follow-up several months later. Quality of the evidence was low to moderate. Available evidence suggested interventions targeting dash-out prevention, crossing at parked cars, and selecting safe routes across intersections were effective. Individualized/small-group training for children was the most effective training strategy based on available evidence. CONCLUSIONS Behaviorally based interventions improve childrens pedestrian safety. Efforts should continue to develop creative, cost-efficient, and effective interventions.

The role of automation in reducing stress and negative affect while driving

Operation of a motor vehicle is a complex task associated with thousands of fatalities and injuries each year. Automation is one way to assist drivers in handling the complexity of the driving task. The current state of automation in vehicles is discussed with an emphasis on relations to stress and mental effects. A transactional model of stress is used to examine the potential role of automation as a mediating factor in the reduction of stress in the driving task. Evidence indicates that automation is likely to decrease mental workload and stress, therefore producing a more positive set of emotional responses. Suggestions are made for future research examining automation in traditional, hybrid and electric vehicles.

School-age children’s safety attitudes, cognitions, knowledge, and injury experiences: how do these relate to their safety practices?

Background: A variety of factors affect the safety and risk practices of school-age children, but rarely have multiple factors been considered simultaneously. Objective: To examine children’s safety attitudes and cognitions more thoroughly and assess how these factors, along with children’s safety knowledge and injury experiences, relate to children’s safety practices. Methods: Over several classroom sessions, boys and girls in two age groups (7–9, 10–12 years) completed a psychometrically sound questionnaire that indexes their behaviors, attitudes, cognitions, knowledge, and injury experiences. Results: Fewer safety practices were reported by older than younger children and boys than girls. Children’s attitudes, cognitions, knowledge, and injury experiences each correlated with safety practices, but only safety attitudes and injury experiences predicted practices in a multivariate model. Conclusion: Exploring the relative influence of numerous factors on safety practices highlights the important role that attitudes play in predicting children’s safety practices. Implications of these results for injury prevention programming are discussed.

The roles of gender, age and cognitive development in children's pedestrian route selection

OBJECTIVE Thousands of American children under the age of 10 years are injured annually as pedestrians. Despite the scope of this public health problem, knowledge about behavioural control and developmental factors involved in the aetiology of child pedestrian safety is limited. The present study examined the roles of gender, age and two aspects of cognitive development (visual search and efficiency of processing) in childrens safe pedestrian route selection. METHODS Measures of cognitive functioning (visual search and efficiency) and selections of risky pedestrian routes were collected from 65 children aged 5-9 years. RESULTS Boys, younger children and those with less developed cognitive functioning selected riskier pedestrian routes. Cognitive functioning also subsumed age as a predictor of risky route selections. CONCLUSIONS Our findings suggest developmental differences, specifically less developed cognitive functioning, play important roles in childrens pedestrian decision making. Directions for future examination are discussed.

A contextual perspective on the etiology of children's unintentional injuries

Abstract Unintentional injury is the leading cause of death in American children aged 1–18. The subject of considerable epidemiological inquiry, study of childrens injuries from a psychological perspective remains somewhat novel and rather atheoretical. In this paper, we explore a contextual perspective on the understanding of the psychological aspects of the etiology of childrens unintentional injuries. Injury is viewed as embedded in dynamic proximal and distal contexts in which children play an influential role. Multiple facets and layers of context for unintentional injuries, as well as childrens role in selecting contextual environments, are examined and illustrated with examples.

Development of the BACKIE questionnaire: A measure of children's behaviors, attitudes, cognitions, knowledge, and injury experiences

OBJECTIVE The objective of this study was to develop a standardized questionnaire (BACKIE) that would assess the Behaviors (B), Attitudes (A), Cognitions (C), Knowledge (K), and Injury Experiences (IE) that elementary-school children possess pertaining to seven types of injuries, including: falls; motor vehicle collisions; burns; drowning; choking/suffocation; poisoning; and bicycle/pedestrian injuries. METHODS Over 500 children in grades two through seven completed the questionnaire, with a sub-sample repeating it two months later to assess test-retest reliability of the measure. RESULTS Psychometric assessment of the instrument revealed acceptable internal and test-retest reliabilities and results of a Confirmatory Factor Analysis provided support for the hypothesized factor structure. CONCLUSION Having a psychometrically sound measure that allows one to assess attitudes, cognitions, and knowledge is an essential first step to exploring the relative influence of these factors on childrens risk and safety practices.

The roles of child, parent and environmental factors in pedestrian supervision

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. We examined parental supervision choices in the context of child pedestrian experience, parent perceptual factors and varying levels of environmental risk. A series of street crossing scenarios were used to examine the roles of child, parent and environmental factors in determining parents’ supervision choices. Parents recognised differing levels of risk across environmental conditions and altered their supervision choices accordingly. Child age and parental risk perception were significantly predictive of supervision choices. Our results demonstrate that parents assess multiple factors when determining the intensity of supervision necessary for their children. Notably, parents adjust their supervision in direct relation to changes in the physical environment. Implications of these findings for injury prevention and future research are discussed.

The impact of artificial vehicle sounds for pedestrians on driver stress

Electrically based vehicles have produced some concern over their lack of sound, but the impact of artificial sounds now being implemented have not been examined in respect to their effects upon the driver. The impact of two different implementations of vehicle sound on driver stress in electric vehicles was examined. A Nissan HEV running in electric vehicle mode was driven by participants in an area of congestion using three sound implementations: (1) no artificial sounds, (2) manually engaged sounds and (3) automatically engaged sounds. Physiological and self-report questionnaire measures were collected to determine stress and acceptance of the automated sound protocol. Driver stress was significantly higher in the manually activated warning condition, compared to both no artificial sounds and automatically engaged sounds. Implications for automation usage and measurement methods are discussed and future research directions suggested. Practitioner Summary: The advent of hybrid- and all-electric vehicles has created a need for artificial warning signals for pedestrian safety that place task demands on drivers. We investigated drivers’ stress differences in response to varying conditions of warning signals for pedestrians. Driver stress was lower when noises were automated.

Detection and Direction Determination of Approaching Vehicle Noises Among Older Adults

We examined detection and direction determination of auditory cues from a pedestrian environment among a sample of older and younger adults. Review of relevant research suggests normal aging is associated with declines in physical, cognitive, and perceptual abilities. Relatively, few studies have examined the impact of such developmental changes on pedestrian safety among older adults, and none have examined such factors in relation to use of auditory cues. Thirty-five younger and 35 older adults completed cognitive measures and a pedestrian auditory detection task. Some results by speed were similar to past research that examined younger samples. Interactions were discovered between age and speed conditions within the auditory task. Results are discussed in the context of past research and with regard to informing future injury prevention efforts.

Developmental Aspects of Unintentional Injury Prevention Among Youth: Implications for Practice

Unintentional injuries, the leading cause of morbidity and mortality among youth in the United States, are burdensome and costly to society. Continued prevention efforts to reduce rates of unintentional injury remain imperative. We emphasized the role of practitioner influence across a linear concept of injury prevention comprising delivery, practice, and application/generalization and within the context of child developmental factors. Specific strategies for injury prevention tailored to the cognitive development stage of the patient are provided. This information may be useful to health care practitioners, who have significant interaction with youth and their families.