Epidemiology and Prevention of Traffic Injuries to Urban Children and Adolescents

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Abstract
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 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.