Epidemiology and prevention of traffic injuries to urban children and adolescents

Objectives. To describe the incidence of severe traffic injuries before and after implementation of a comprehensive, hospital-initiated injury prevent ion program aimed at the prevention of traffic injuries to school-aged chil dren in an urban community. Materials and Methods. Hospital discharge and death certificate data on sev ere pediatric injuries (ie, injuries resulting in hospital admission and/or death to persons age <17 years) in northern Manhattan over a 13-year perio d (1983-1995) were linked to census counts to compute incidence. Rate ratio s with 95% CIs, both unadjusted and adjusted for annual trends, were calcul ated to test for a change in injury incidence after implementation of the H arlem Hospital Injury Prevention Program. This program was initiated in the fall of 1988 and continued throughout the study period. It included 1) sch ool and community based traffic safety education implemented in classroom s ettings in a simulated traffic environment, Safety City, and via theatrical performances in community settings; 2) construction of new playgrounds as well as improvement of existing playgrounds and parks to provide expanded o ff-street play areas for children; 3) bicycle safety clinics and helmet dis tribution; and 4) a range of supervised recreational and artistic activitie s for children in the community. Primary Results. Traffic injuries were a leading cause of severe childhood injury in this population, accounting for nearly 16% of the injuries, secon d only to falls (24%). During the preintervention period (1983-1988), sever e traffic injuries occurred at a rate of 147.2/100 000 children <17 years p er year. Slightly <2% of these injuries were fatal. Pedestrian injuries acc ounted for two thirds of all severe traffic injuries in the population. Amo ng school-aged children, average annual rates (per 100 000) of severe injur ies before the intervention were 127.2 for pedestrian, 37.4 for bicyclist, and 25.5 for motor vehicle occupant injuries. Peak incidence of pedestrian and bicyclist injuries occurred during the sum mer months and afternoon hours, whereas motor vehicle occupant injuries sho wed little seasonal variation and were more common during evening and night -time hours. Age-specific rates showed peak incidence of pedestrian injurie s among 6- to 10-year-old children, of bicyclist injuries among 9- to 15-ye ar-old children, and of motor vehicle occupant injuries among: adolescents between the ages of 12 and 16 years. The peak age for all traffic injuries combined was 15 years, an age at which nearly 3 of every 1000 children each year in this population sustained a severe traffic injury. Among children hospitalized for traffic injuries during the preintervention period, 6.3% sustained major head trauma (including concussion with loss o f consciousness for greater than or equal to 1 hour, cerebral laceration an d/or cerebral hemorrhage), and 36.9% sustained minor head trauma (skull fra cture and/or concussion with no loss of consciousness greater than or equal to 1 hour and no major head injury). The percentage of injured children wi th major and minor head trauma was higher among those injured in traffic th an among those injured by all other means (43.2% vs 14.2%, respectively; ch i(2) = 336; degrees of freedom = 1). The percentages of children sustaining head trauma were 45.4% of those who were injured as pedestrians, 40.2% of those who were injured as bicyclists, and 38.9% of those who were injured a s motor vehicle occupants. During the intervention period, the average incidence of traffic injuries a mong school aged children declined by 36% relative to the preintervention p eriod (rate ratio: .64; 95% CI: .58, .72). After adjusting for annual trend s in incidence, pedestrian injuries declined during the intervention period among school aged children by 45% (adjusted rate ratio: .55; 95% CI: .38, .79). No comparable reduction occurred in nontargeted injuries among school -aged children (adjusted rate ratio: .89; 95% CI:.72, 1.09) or in traffic i njuries among younger children who were not targeted specifically by the pr ogram (adjusted rate ratio: 1.32; 95% CI: .57, 3.07). Conclusion. Child traffic injuries, particularly those involving pedestrian s, are a major public health problem in urban communities. Although the inc idence of child pedestrian injuries is declining nationally and internation ally, perhaps attributable to declines in walking, this trend may not be ap plicable in inner city communities such as northern Manhattan, in which wal king remains a dominant mode of transportation. Community interventions inv olving the creation of safe and accessible play areas as well as traffic sa fety education and supervised activities for school-aged children may be ef fective in preventing traffic injuries to children in these communities. Ad ditional controlled evaluations are needed to confirm the benefits of such interventions.