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PEDIATRICS Vol. 103 No. 6 June 1999, p. e74
Received Jun 15, 1998; accepted Dec 14, 1998.
, §,
, and
From the * Gertrude H. Sergievsky Center, Faculty of Medicine,
and Division of Epidemiology, Joseph L. Mailman School of Public
Health, Columbia University, New York, New York; § New York State
Psychiatric Institute, New York, New York; ¶ College of Physicians and
Surgeons Columbia University at Harlem Hospital, Department of
Pediatrics, New York, New York; New York City Department of
Transportation, Safety Division, New York, New York; and # Division of
Pediatrics and Pediatric Surgery, Harlem Hospital Center, New York, New
York.
Objectives. To describe the incidence of severe traffic injuries before and after implementation of a comprehensive, hospital-initiated injury prevention program aimed at the prevention of traffic injuries to school-aged children in an urban community.
Materials and Methods. Hospital discharge and death certificate data on severe pediatric injuries (ie, injuries resulting in hospital admission and/or death to persons age <17 years) in northern Manhattan over a 13-year period (1983-1995) were linked to census counts to compute incidence. Rate ratios with 95% CIs, both unadjusted and adjusted for annual trends, were calculated to test for a change in injury incidence after implementation of the Harlem Hospital Injury Prevention Program. This program was initiated in the fall of 1988 and continued throughout the study period. It included 1) school and community based traffic safety education implemented in classroom settings 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 off-street play areas for children; 3) bicycle safety clinics and helmet distribution; and 4) a range of supervised recreational and artistic activities 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, second only to falls (24%). During the
preintervention period (1983-1988), severe traffic injuries occurred
at a rate of 147.2/100 000 children <17 years per year. Slightly
<2% of these injuries were fatal. Pedestrian injuries accounted for
two thirds of all severe traffic injuries in the population. Among
school-aged children, average annual rates (per 100 000) of severe
injuries 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 summer months and afternoon hours, whereas motor vehicle occupant injuries showed little seasonal variation and were more common
during evening and night-time hours. Age-specific rates showed peak
incidence of pedestrian injuries among 6- to 10-year-old children, of
bicyclist injuries among 9- to 15-year-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 of consciousness for 
1 hour, cerebral
laceration and/or cerebral hemorrhage), and 36.9% sustained minor head
trauma (skull fracture and/or concussion with no loss of consciousness 1 hour and no major head injury). The percentage of injured children with major and minor head trauma was higher among those injured in
traffic than among those injured by all other means (43.2% vs 14.2%,
respectively; 
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 as
motor vehicle occupants. During the intervention period, the average incidence of traffic
injuries among school aged children declined by 36% relative to the
preintervention period (rate ratio: .64; 95% CI: .58, .72). After
adjusting for annual trends 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 injuries among
younger children who were not targeted specifically by the program
(adjusted rate ratio: 1.32; 95% CI: .57, 3.07).
Conclusion. Child traffic injuries, particularly those involving pedestrians, are a major public health problem in urban communities. Although the incidence of child pedestrian injuries is declining nationally and internationally, perhaps attributable to declines in walking, this trend may not be applicable in inner city communities such as northern Manhattan, in which walking remains a dominant mode of transportation. Community interventions involving the creation of safe and accessible play areas as well as traffic safety education and supervised activities for school-aged children may be effective in preventing traffic injuries to children in these communities. Additional controlled evaluations are needed to confirm the benefits of such interventions. Key words: adolescent, bicyclist, child, community, epidemiology, evaluation, incidence, injury, motor vehicle, pedestrian, prevention, traffic.
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