Introduction to the Study
Over the last three decades, Oakland has recorded one of the highest rates of childhood mortalities and injuries resulting from automobile collisions. The heavy traffic in Oakland and the large population within most Oakland neighborhoods are two main factors that contribute to the problem. However, the lack of proper public health-based initiatives to curb the menace should be considered as a failure and should be the critical point at which public health intervention programs must begin. Although the Federal Highway Administration in conjunction with the Institute of Transport Engineers has over the last few years been conducting research to determine how ‘traffic calming’ can be implemented in the national highways, there has been little advance in initiating significant projects, which further explains why the rate of childhood pedestrian injuries and deaths remains high. Moreover, the majority of studies on road safety focusing on traffic calming often place an emphasis on assessing the accident statistics and often after the implementation of certain traffic calming initiatives. According to most studies, it is clear that hospital-based information on specific impacts of the interventions is really lacking in the public health and research fields.
Purpose of the Study
The study was developed to determine the most viable process of reducing childhood pedestrian injuries and deaths in Oakland, California. The aim was to find information that will help the researchers in developing the most appropriate public health information in order to critically examine the problem and find the most appropriate solution. Secondly, the study aims at developing an understanding of the problem and how it can be solved under public health interventions. Previous empirical studies have produced statistical information regarding the problem, but few have attempted to consider applying this information to solve the problem from a public health perspective.
Significance of the study
Solving a public health problem with the relevant study is an important aim in this study. In this context, the fact that the problem under study results from a lack of information as well as poor application of public health initiatives to reduce the number of childhood pedestrian deaths at Oakland calls for an empirical study that will examine the problem and find a better solution. In fact, it is expected that the results will be useful for policy making in the public health and transport sectors.
Aims and objectives of study
- Finding the most relevant information regarding childhood pedestrian mortality and injuries
- Locating the most relevant literature relating to the public health problem posed by childhood pedestrian injuries and deaths
- Looking for qualitative and quantitative information regarding the available solutions to the public health problem and
- Using these sets of information to determine the most applicable method in reducing childhood pedestrian injuries and deaths at Oakland, California
- Does the rate of childhood pedestrian death and injuries pose a public health problem in Oakland, California?
- What information is needed to reduce the increasing number of childhood injuries and deaths in Oakland highways and roads?
- What public health initiatives are likely to provide the public health sector with a solution to curb the problem of childhood pedestrian injuries and deaths in Oakland?
Within the context of public health, the study hypothesized that the public health sector at Oakland is challenged by the problem of an increasing number of childhood pedestrian deaths and injuries, which calls for emergent public health measures.
Review of literature
According to the national institute of health, pedestrian injuries caused by vehicle collisions are among the leading causes of child death in the United States. Included in this category are the children aged between 5 and 14 years, while the mortality rate increases every year. According to Grossman (2000), the demographic characteristics of the children victims of automobile collisions remained the same for the 20 years between 1980 and 2000, where the age of the majority of victims fall between 5 and 9 years. According to Mueller, Rivara, Lii and Weiss (2002), children living in low socioeconomic neighborhoods are the most affected. Rivara (2008) has shown that the majority of the victims are the children en route to and from school as well as those playing near their neighborhoods. Rivara further argues that modification of traffic patterns could prove to be a highly sustainable and passive public health initiative in improving children living environments. However, this requires massive resources, as it calls for massive engineering and reengineering strategies, all of which fall under the ‘traffic calming’ category. While a number of European nations have successfully implemented traffic calming initiatives to reduce motor vehicle collisions involving children, there has been very little effort to take similar steps in the United States. This explains why childhood pedestrian injuries and deaths remain a public health concern in America (Ewing, 2009).
According to the National Center for Health Statistics (2000), automobiles are responsible for one out of every five death of children aged between 1 and 14 years in the United States. In addition, according to the National Center for Injury Prevention and Control (2002), pedestrian injuries account for more than 75% of them. Pedestrian injuries and deaths involving child victims are five-time higher than the number of occupant victims during such incidences. In fact, studies have shown that there is a fivefold higher probability of childhood death among pedestrians than among motor vehicle occupants. Since, 1998, more than 700 children are killed every year, while over 30,000 receive nonfatal to fatal injuries annually due to traffic collisions. According to National Center for Health Statistics (2000), these figures exclude the number of children stuck in parking lots, driveways or those stuck in non-traffic areas and neighborhoods. Moreover, more than half of the injured children suffer from traumatic brain injury, which may last throughout their lives.
Although some studies have shown a decrease in the number of child pedestrian deaths over the last two decades, it is worth noting that the decline has only occurred in some areas, while in other areas, it is actually on the increase. In some areas, the decline has been recorded because of reduced exposure of the children to vehicle collisions. Studies have shown that the impact of a safer environment is insignificant in the reduction of the incidences. In fact, according to DiGuiseppi, Roberts and Li (2007), most parents have resolved to prohibit their children from walking in order to provide them with safety. Although this is effective in reducing the number of childhood pedestrian deaths and injuries in a number of areas, it is worth noting that it is equally negative to childhood health, given that walking is one of the most important exercises for childhood growth and development. This phenomenon could be partly responsible for the increasing number of childhood obesity, which is now an epidemic in the United States. Therefore, this implies that prohibiting the children from taking walking as an exercise as a way of protecting them from motor vehicle collision is not necessary as it equally exposes them to more public health problems.
Over the last few decades, much research has been conducted to determine the various aspects and facets of childhood pedestrian injury and deaths. According to a study by Rivara (2000), children are more likely to be hit by motor vehicles than any other demographic group. Secondly, Rivara (2000) has shown that children are more likely to be involved in such collisions in urban areas or on residential streets during the early morning hours as they go to school and during the evening hours as they return home from school. In addition, studies indicate that children are likely to be struck when playing near roads within their neighborhoods, especially in neighborhoods where main roads and highways pass. This is unlike in adult pedestrian accidents, where they are likely to be involved when drunk, at night and during the holiday. According to Winn, Agran and Castillo (2001), children expose themselves to pedestrian accidents in a number of areas, especially during midblock dart-outs, across intersections and across parking lots. In addition, children’s ability to alight from public buses is a factor that puts them at risk, especially where they are left to travel alone. According to Rivara and Barber (1998), the age and gender factors determine where and how the child was involved in an accident. Boys are more exposed to traffic than girls- a factor that implies that boys are more exposed to childhood pedestrian accidents than girls are. Considering the age factor, it is important to note that the degree of child independence and mobility is a matter determined by the age of the child. For instance, infants can only be considered as pedestrians when an adult or an older child in arms, strollers or even bikes carries them. This implies that the risk of infant pedestrian injuries and deaths is significantly low. Toddlers aged between one and two years bear the largest number of incidences involving pedestrian injuries and deaths. Some of the major factors contributing to this include their relatively small sizes of the body as well as low exposure and experience with traffic. These children are also the most affected in incidents that take place in non-traffic locations. However, according to Agran, Castillo and Winn (2000), studies indicate that the reporting of such incidents is relatively low because such areas as driveways and parking lots are not traffic areas.
Children in the preschool age (3-4 years), as well as those in the lower elementary schools (up to 9 years), are mostly involved in motor vehicle collisions as pedestrians as they walk along roads, entering the roadway at midblock and other such areas. This is particularly true if there are several vehicles parked along the roads, which may shield the drivers from viewing the passing children. According to Schieber and Thompson (2006), the conceptual ski8ls and knowledge possessed by these children are still developing, which exposes them to the risk of injuries and deaths. The mobility and level of activity increase as a child grows in age and size. This also increases with the level of independence and a decrease in the degree of supervision. As such, the older children travel far, have high activity and prefer discovering new areas by themselves. In addition, the level of activity implies that such children are likely to play anywhere, including along the roads. Such children, especially those aged between 5 and 9 years, are more exposed to the risks of childhood pedestrian deaths and injuries than any other group. According to Agran, Winn and Anderson (2004), preadolescent and young adolescent children (those aged between 10 and 14 years) will have acquired some experience with traffic. They are therefore likely to make proper decisions when using roads and highways. However, such children are also at the risk, especially in busy streets and highways.
Looking at the risk factors, it is evident that a number of factors expose children to injuries. For instance, parents sometimes tend to have unrealistic expectations of their children, especially by assuming that the child has grown of age and is in a position to make proper decisions when using roads and highways. They tend to assume that the experience that their children have with traffic is enough to make them remain obedient to traffic rules and avoid incidents (Dunne, Asher & Rivara, 2002). Secondly, the proximity of the school from the place of residence exposes the children to accidents. For instance, it has been shown that children who travel far to school from their homes run under a greater degree of risk than those whose homes are relatively close to the schools. In addition, family income and poverty levels expose the children to risks. For instance, parents who have the capacity to pay for the daily transport to and from school have their children’s risk of pedestrian traffic injury reduced significantly. Moreover, the absence of parental guidance on the roads determines the degree of risk, with the children from working parents having the least chance of being guided to and from school every day as their parents are busy at the workplace. Other risk factors include the volume of traffic on the roads, the design used in road and street construction, the availability of alternative facilities such as over and underpasses and the volume of pedestrians on the streets and roads. Drive-based risk factors are also worth considering when attempting to develop public health interventions (Wazana, Krueger, Raina et al., 2004). For instance, inattention, overspeeding, driving under the influence of alcohol and drugs expose the children to risks (Baker, Robertson & O’Neill, 2000).
The case of Oakland, California
Childhood pedestrian injuries and deaths have been major public health issues in California over the last few decades. The large volumes of traffic, as well as pedestrian overcrowding all, contribute to the high prevalence of these incidents. The high prevalence has been significant over the years, and in fact, triggered the establishment of the Oakland Pedestrian Safety Project. One of the main aims of this alliance was to address child pedestrian injuries in and near the city of Oakland. It advocated for the installation of bumps and other roads signs throughout the city. Although these initiatives reduced the number of injuries and deaths, children victims of vehicle collisions remain relatively high in the city, calling for additional research to determine the most appropriate public health intervention.
This study will be a quantitative study, which will make use of match-case control analysis of children victims of road accidents. The study will aim at the children aged between the age of 5 to 15 years admitted to specific hospitals with injuries obtained from the roads, but as pedestrians and not occupants. Observations and case comparisons will be used as data collection methods in the study, where each of the case patients will be compared with two controls matched according to their gender and age. The purpose of this technique will be to determine whether the specific public health intervention placed within the respective position where each case-patient met the incident is effective as per its intended functions.
Case identification (inclusion and exclusion criteria)
The study targets case patients retrospectively from three hospitals in Oakland, where the children are mostly taken after being involved in road accidents. To qualify for the study, the child is between 5 and 15 years, be of sound mind and not handicapped before the accident. In addition, the child must have been a pedestrian during the incident.
Data collection methods
The researcher will review charts and data sheets on emergent medical services in order to eliminate those children whose injuries were obtained in non-traffic areas, those who were involved in the accidents while riding or those who were along driveways. In addition, the researcher will seek data from the Department of Police offices at Oakland. Moreover, the case patients must have been involved in the accident at a distance not more than 1.0 km from their homes and must be Oakland residents.
Data Analysis (analysis of the anticipated results)
The study was conducted with the main aim of finding a solution to the public health problem posed by the massive number of childhood deaths and injuries resulting from automobile collisions within their Oakland neighborhoods and along highways. The chosen study methodology was devised and applied in order to find the most relevant data.
As mentioned above, the study will aim at matching the case-patient with two controls of the same age and gender. Statistical data analysis will be performed with SPSS (SPSS v 18.0) to match the pairs, the researcher will use the McNemar matched pairs model in order to make the examination of the cases effective and concise. The researcher will target 50 cases and 100 controls for comparison under the case match.
The researcher identified 118 children who had been admitted to the emergency department of the hospitals during the time of the study. Out of these, some 26 cases were eliminated from the study because they did not meet the inclusion criteria. In addition, the researcher eliminated some 42 cases because they had received their injuries outside their residential neighborhoods. Therefore, the sample for the study was 50 patients.
The researcher identified 100 case controls to match the case-patients in terms of age, income background, gender and status of insurance. The study found that most of the case-patients had a high likelihood of being Hispanics, Latinos and Asian. The study further found that Latinos and Hispanic children had a 2.9 times higher likelihood of being injured than their white counterparts. This indicates that the P results were (P= 0.9). In addition, the likelihood of Asian children being injured was 2.25 times higher than that of white children (P= 0.19). Moreover, it was found that the likelihood of African-American children being involved in pedestrian collisions with vehicles in the city of Oakland was 3.2 times higher than that of white children.
From the case match study, the data analysis indicates that the white children have the lowest likelihood of receiving injuries on the city roads. Secondly, Latinos and Hispanics have a relatively higher likelihood of injuries than Asians do, while African American children have the highest likelihood of receiving such injuries.
Figure: Demographic characteristics of the study sample
Despite the relatively low number of African American people in the city and among the study sample, this study shows that this minority group bears the highest degree of risks related to childhood pedestrian injuries, followed closely by the Latinos/Hispanics and the Asians. From these findings, it is necessary to consider the socioeconomic backgrounds of the patients. First, it is likely that African-American children are more likely to be involved in collisions with vehicles because the poverty level among this minority group is relatively higher than that of the Latinos, Hispanics, Asians and whites. The ability of the African-American parents to drive their children to and from school or to walk them is relatively lower than that of the other groups. This also applies to the Asians and the Latino/Hispanics groups when compared to the whites.
This study provides some information on the issues related to childhood pedestrian injuries, which can be used in finding the best solution to the problem. First, it is evident that the level of poverty is an important factor that determines the likelihood of the children being involved in pedestrian collisions with automobiles. Secondly, despite the large number of speed bumps erected on the Oakland roads, the childhood pedestrian injuries present a public health issue that needs emergent attention. Finally, this study reveals a need for additional ‘traffic calming’ initiatives to reduce the problem as well as additional studies to reveal additional information on the most effective way of ‘traffic calming’.
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