Published online May 1, 2007
PEDIATRICS Vol. 119 No. 5 May 2007, pp. 1040-1042 (doi:10.1542/peds.2007-0370)

This Article Extract Full Text (PDF) Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Desapriya, E. B.R. Articles by Subzwari, S. Search for Related Content PubMed PubMed Citation Articles by Desapriya, E. B.R. Articles by Subzwari, S. Related Collections Office Practice Social Bookmarking                         What's this?

LETTER TO THE EDITOR

Deterrent to Healthy Lifestyles in Our Communities

Ediriweera B.R. Desapriya, PhD
Ian Pike, PhD
Anamaria Basic, BSc
Sayed Subzwari, MHSc
Department of Pediatrics
British Columbia Injury Research and Prevention Unit
Centre for Community Child Health Research
Vancouver, British Columbia, Canada V6H 3V4

To the Editor.—

We certainly agree with the recent letter to the editor of Pediatrics¹ that emphasized that the current epidemic of obesity requires prevention work on several fronts including the identification of barriers to healthy lifestyles in our communities. In addition, we also believe that it is important to identify best practices of obesity prevention irrespective of whether they are active or passive. However, the author raised a very important perspective: "Our reliance on the automobile and our propensity to design our urban environments for cars rather than for people may well be an additional root cause of the obesity epidemic."¹ Transport is an important determinant of public health. It affects physical activity levels, crashes and injuries, social and economic opportunities, and general well-being.² Extensive literature on the various health benefits of physical activity has necessitated the understanding of determinants, risks, and barriers to physical activity.

It has been highlighted that one of the biggest epidemics facing the world in the 21st century is the growing obesity in children. This epidemic has been attributed largely to sedentary lifestyles. Therefore, it is critical to identify the barriers and the potentially effective strategies for surmounting the problems that hinder walking and cycling.³

In 1969, approximately half of all schoolchildren in the United States walked or bicycled to or from school. Today, fewer than 15% of children and adolescents use these active modes of transportation.⁴ In recent years, new public health challenges have brought the issue of the decline of young people's physical activities to the forefront. One recent study in the United States explored the question of why children do not walk to school more often. Parents reported multiple barriers that inhibit walking and biking to school as follows: long distances (55%), traffic danger (40%), weather (24%), crime (18%), and school policy (7%). Similarly, in the United Kingdom a recent study showed that 85% of parents were worried about traffic dangers on their children's journey to school.⁵

Parents discourage their children from walking or cycling to school because they worry about the dangers from traffic.⁶ As a result, less than half primary school–aged children are now walking to school in the United Kingdom.⁷

Many neighborhoods lack sidewalks, bike lanes, and safe paths or have dangerously fast traffic. Barriers to routine physical activity have sprung up nearly everywhere in the lives of children. At the same time, children have an ever-increasing set of sedentary indoor entertainment to keep them occupied. Although public health policies encourage more children to walk and cycle to school, this can only happen when parents' rightful worries about their children's safety are addressed adequately.

A recent study shows that in the 5- to 9-year-old age group, sport utility vehicles (SUVs) were 4 times as likely to be associated with fatal pedestrian injury (odds ratio: 4.2; 95% confidence interval: 1.9–9.5). It was concluded that vehicle body-type characteristics play an important role in fatal pediatric pedestrian injuries.⁸ Reducing SUVs' frontal design seems then to be a worthwhile public health endeavor.

Road danger is a real disincentive to active transport, and reducing traffic-injury risks for child pedestrians and cyclists should be an important part of any strategy to encourage walking and cycling, which then will assist in increasing active lifestyles in our communities and subsequently reducing childhood obesity. A recent study in the United Kingdom suggested that more needs to be done in this respect.⁹ If children avoid walking and bicycling because of parental fears (justified or not) of them being injured by motor vehicles, then the disease burden includes inactivity, and the total burden of disease will be much larger than the World Health Organization predicts for 2020.¹⁰

In 2001, an estimated 685000 children under the age of 15 were killed by unintentional injuries. Approximately 20% of all global deaths from unintentional injuries occur in this age group, which makes unintentional injury among the 10 leading cause of death in our children.¹¹

Are our driveways even safe? Children playing in driveways are at risk of fatal and serious injury caused by reversing vehicles.¹² Driveway injuries are an underrecognized, often severe form of motor vehicle–pedestrian crashes. Injuries within residential driveways occur most often to children younger than 5 years and carry a significant risk of injury and mortality. Recent research shows that with the increasing popularity of SUVs, minivans, and large-model pick-up trucks, children involved in driveway back-over fatal injuries are increasing in the United States and Australia.^12–15

Similarly a recent study in Brazil showed that many young children playing in driveways are often killed by SUVs.¹⁶ Parks and playgrounds are the most obvious locales for creating active environments for kids, yet in developing countries there is a dearth of safe outdoor facilities. One recent study showed that increasing the number of public parks correlates with a decreased rate of motor vehicle–related mortality in young children.¹⁷

The vast majority of unintentional injuries among children occur in low- and middle-income countries, and children in African, southeast Asian, and Western Pacific regions account for 80% of all deaths from unintentional injuries.¹⁸ Coupled with the lack of resources available for unintentional injury prevention and control in developing countries, this increase in motor vehicle danger portends a holocaust of preventable child deaths.

Systematic reviews have suggested that traffic-calming schemes do reduce the number of accidents by 15%,¹⁹ and a recent Cochrane review²⁰ of area-wide traffic-calming in towns and cities suggested that it may be a promising intervention for reducing the number of road-traffic injuries and deaths, with a pooled rate ratio of 0.89 (95% confidence interval: 0.80–1.00).

Much promising current research shows that the level of pedestrian protection provided by motor vehicles can be significantly improved with practicable design changes. Road deaths can be greatly reduced by improving vehicle design; however, the automobile industry is resisting this in favor of style and speed.²¹

Therefore, policy-makers need to do work that would require automakers to design more pedestrian-friendly vehicles. Pediatricians should consider any work in vehicle design that aims to reduce the injury severity to child pedestrians to be vitally important.

REFERENCES

1. Fisk J. Childhood obesity: a passive route to physical activity. Pediatrics. 2007;119 :423[Free Full Text]
2. Morrison DS, Petticrew M, Thomson H. What are the most effective ways of improving population health through transport interventions? Evidence from systematic reviews. J Epidemiol Community Health. 2003;57 :327 –333[Abstract/Free Full Text]
3. Desapriya E, Pike I, Babul S. Health benefits of physical activity. CMAJ. 2006;175 :776[Free Full Text]
4. Martin S, Carlson S. Barriers to children walking to or from school: United States, 2004. JAMA. 2005;294 :2160 –2162[Free Full Text]
5. Rowland D, DiGuiseppi C, Gross M, Afolabi E, Roberts I. Randomized controlled trial of site specific advice on school travel patterns. Arch Dis Child. 2003;88 :8 –11[Abstract/Free Full Text]
6. British Medical Association Board of Science and Education. Injury Prevention. London, United Kingdom: British Medical Association; 2001
7. Robertson D. Less than half of pupils walk to school. Daily Mail. July 9, 2006. Available at: http://tinyurl.com/kaslc. Accessed March 9, 2007
8. DiMaggio C, Durkin M, Richardson LD. The association of light trucks and vans with paediatric pedestrian deaths. Int J Inj Contr Saf Promot. 2006;13 :95 –99[CrossRef][Medline]
9. Sonkin B, Edwards P, Roberts I, Green J. Walking and cycling and transport safety: an analysis of child road deaths. J R Soc Med. 2006;99 :402 –405[Abstract/Free Full Text]
10. Desapriya E, Pike I, Joshi P. Risks on the roads. CMAJ. 2006;174 :1743[Free Full Text]
11. World Health Organization. Shape healthy environments for children. 2002. Available at: www.who.int/world-health-day/2003/infomaterials/Hec-BroEn.pdf. Accessed March 9, 2007
12. Nadler EP, Courcoulas AP, Gardner MJ, Ford HR. Driveway injuries in children: risk factors, morbidity, and mortality. Pediatrics. 2001;108 :326 –328[Abstract/Free Full Text]
13. Pinkney KA, Smith A, Mann NC, Mower GD, Davis A, Dean JM. Risk of pediatric back-over injuries in residential driveways by vehicle type. Pediatr Emerg Care. 2006;22 :402 –407[CrossRef][Web of Science][Medline]
14. Holland AJ, Ross FI, Manglick P, Fahy FE, Cass DT. Driveway motor vehicle injuries in children: a prospective review of injury circumstances. Med J Aust. 2006;184 :311[Web of Science][Medline]
15. Fenton SJ, Scaife ER, Meyers RL, Hansen KW, Firth SD. The prevalence of driveway back-over injuries in the era of sports utility vehicles. J Pediatr Surg. 2005;40 :1964 –1968[CrossRef][Web of Science][Medline]
16. Waksman RD, Pirito RMBK. The pediatrician and traffic safety. J Pediatr (Rio J). 2005;81 (5 suppl):S181–S188
17. Nakahara S, Nakamura Y, Ichikawa M, Wakai S. Relation between increased numbers of safe playing areas and decreased vehicle related child mortality rates in Japan from 1970 to 1985: a trend analysis. J Epidemiol Community Health. 2004;58 :976 –981[Abstract/Free Full Text]
18. Peden M, Scurfield R, Sleet D, et al. World Report on Road Traffic Injury Prevention. Geneva, Switzerland: World Health Organization; 2004. Available at: www.who.int/world-health-day/2004/infomaterials/world_report/en/summary_en_rev.pdf. Accessed March 9, 2007
19. Elvik R. Area-wide urban traffic calming schemes: a meta-analysis of safety effects. Accid Anal Prev. 2001;33 :327 –336[CrossRef][Web of Science][Medline]
20. Bunn F, Collier T, Frost C, et al. Area-wide traffic calming for preventing traffic related injuries [Cochrane review]. In: The Cochrane Library. Issue 3. Oxford, United Kingdom: Update Software; 2003
21. Pless B. Road traffic injury prevention. BMJ. 2004;328 :846[Free Full Text]

---

PEDIATRICS (ISSN 1098-4275). ©2007 by the American Academy of Pediatrics

CiteULike    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This Article Extract Full Text (PDF) Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Desapriya, E. B.R. Articles by Subzwari, S. Search for Related Content PubMed PubMed Citation Articles by Desapriya, E. B.R. Articles by Subzwari, S. Related Collections Office Practice Social Bookmarking                         What's this?