Child Bicyclists Research Articles

A Child-Friendly Wearable Device for Quantifying Environmental Risk Factors for Myopia.

In the past few decades, the prevalence of myopia, where the eye grows too long, has increased dramatically. The visual environment appears to be critical to regulating the eye growth. Thus, it is very important to determine the properties of the environment that put children at risk for myopia. Researchers have suggested that the intensity of illumination and range of distances to which a child's eyes are exposed are important, but this has not been confirmed. We designed, built, and tested an inexpensive, child-friendly, head-mounted device that can measure the intensity and spectral content of illumination approaching the eyes and can also measure the distances to which the central visual field of the eyes are exposed. The device is mounted on a child's bicycle helmet. It includes a camera that measures distances over a substantial range and a six-channel spectral sensor. The sensors are hosted by a light-weight, battery-powered microcomputer. We acquired pilot data from children while they were engaged in various indoor and outdoor activities. The device proved to be comfortable, easy, and safe to wear, and able to collect very useful data on the statistics of illumination and distances. The designed device is an ideal tool to be used in a population of young children, some of whom will later develop myopia and some of whom will not. Such data would be critical for determining the properties of the visual environment that put children at risk for becoming myopic.

Blame attribution analysis of police motor vehicle collision reports involving child bicyclists

BackgroundInjuries resulting from collisions between a bicyclist and driver are preventable and have high economic, personal and societal costs. Studying the language choices used by police officers to describe factors...

Understanding children's cycling route selection through spatial trajectory data mining

A sustainable alternative transportation mode to address growing transportation and environmental stress is cycling, which is eco-friendly and healthy for humans. Improving the quality of the bicycling experience is crucial for increasing bicycle use. Good bicycling experience is more critical for child bicyclists because they are less experienced and need more space for error. Therefore, a scientific assessment of child bicyclist perception of selected route safety, comfort, and environment is of great interest. Finding an effective way to learn child bicyclist behavior and help them reduce cycling risk is necessary. In response to this need, we utilize a data mining model to develop a methodology for measuring children's bicycling route safety conditions by evaluating multiple road safety-related features. The proposed method uses a set of route features representing the situation of street environments extracted from state data and first-hand children’s bicycle trajectory data collected using Global Positioning Systems (GPS) from volunteer children bicyclists. A random forest (RF), a well-known classifier, is adopted to predict child bicyclists' behavior. We extract the different route segments between children’s selected routes and the shortest path to learn the child bicyclists' behavior and use the selected best features to interpret their changing cycling behavior. The result shows that children bicyclists' behavior could be analyzed by giving trajectory and nearby road safety situation data. Our model achieves a promising accuracy with an average rate of 92% over multiple scenarios, demonstrating the proposed method's feasibility and the effectiveness of selected features. In addition, we compare our feature effectiveness with the state's generated road safety score data to evaluate the feature robustness. Our features outperform the safety score feature with an average of 10% improvement in prediction accuracy. Furthermore, our method proposes a model framework that can be applied to different study regions and adult bicycling behavior learning.

Physiological status and anatomical severity factors associated with child versus adult bicyclist fatalities based on a national trauma dataset

Bicyclists still account for the majority of child deaths in traffic accidents, despite a gradual decrease in incidence. Therefore, we investigated factors associated with child and adult bicyclist fatalities. In this retrospective study, we used data from a national hospital-based database, the Japan Trauma Data Bank. Data from 2004 to 2019 were obtained for child cyclists (5–18 years; n = 4832) and adult cyclists (26–45 years; n = 3449). In each age group, physiological variables, outcomes, and injury severity were compared between fatal and non-fatal cases. Multivariate logistic regression was performed to determine factors associated with fatality. In adults, fatality was associated with lower values for body temperature, Glasgow Coma Scale score, and Abbreviated Injury Scale (AIS) score for the neck and upper extremities, and with higher values for respiratory rate, heart rate, focused assessment with sonography for trauma positivity rate, and AIS scores for the head, chest, and abdomen. In children, fatality was associated with lower values for body temperature and the Glasgow Coma Scale score, and with higher values for the AIS chest score. These findings point to factors associated with bicyclist fatalities and may help in the development of effective strategies to reduce these fatalities.

Accelerating Upstream Together: Achieving Infant Health Equity in the United States by 2030.

Accelerating Upstream Together: Achieving Infant Health Equity in the United States by 2030.

‘[I]f It’s a Public Health and Safety Thing … Why Not Just Give the Kids Helmets?’: Policing Mandatory Helmet Laws in New South Wales

In the early 1990s Australia became the first country in the world to introduce laws mandating the wearing of helmets by bicyclists. Road safety – particularly for child bicyclists – was the primary driver of change. This article considers the operation of the mandatory helmet law in New South Wales (‘NSW’) with the aim of assessing whether, in light of recent changes to the law and contemporary enforcement practices, its operation is consistent with the animating concern for cyclist safety. Analysis of quantitative data on issued penalty notices shows the law has been heavily enforced and with significant geographical disparity. Analysis of qualitative data derived from interviews with lawyers and others with knowledge of the operation of the law (n = 27) reveals a punitive fine-based enforcement system that is producing serious unintended and ancillary harms. The most significant of these are disturbing levels of over-policing and the accumulation of crippling levels of fine debt.

Is bicycling getting safer? Bicycle fatality rates (1985–2017) using four exposure metrics

The National Highway Traffic Safety Administration cites decreasing bicyclist fatalities in the United States over the past several decades as evidence of improved bicycling safety. However, with users possessing a diverse range of tolerances, purposes, and socio-demographics, bicycle safety is an important yet complex problem, one that does not have a simple yes/no answer. To gain a better understanding, we need to take a variety of perspectives. Traditional bicycle safety analyses take a transportation engineering perspective by using distance-based exposure metrics or those based on the number of trips. But there are other perspectives – such as public health (using population) and transportation planning (using bicycle participation) – that could provide us with a fuller picture. This paper applies four measures of bicycling exposure to take a broad, interdisciplinary perspective on bicycling safety to answer the question of whether bicycling is actually getting safer and, if so, for whom. We first explore age differences with respect to the direction and magnitude of bicyclist fatality rates in the United States between 1985 and 2017. We then investigate whether any safety benefits are shared equally among commuters and recreational riders.Using fatality data from the Fatality Analysis Reporting System (FARS) and exposure data from the National Household Travel Survey (NHTS), the American Community Survey (ACS), the U.S. Census, and the National Sporting Goods Association (NSGA) – a relatively novel approach to measuring exposure through a comprehensive national bicycling participation survey – we derived trends of age-specific bicyclist fatality rates and corresponding confidence intervals for children and adults. We also compare exposure to fatality outcomes by deriving Pearson's correlation coefficients. This is the first research to provide a longitudinal, age-specific statistical analysis of bicycle fatality rates using these four exposure metrics.Results suggest that overall declines in bicycle fatality rates have been primarily driven by a sharp decline in child bicyclist fatalities while adult bicycle fatality rates have generally trended upwards (especially for the general population) or remained stagnant (for commuters). This work adds to the understanding of bicyclist safety and gives direction to future research regarding the importance of considering age and exposure sources.

Quantifying suppressed child pedestrian and bicycle trips

Traditional pedestrian and bicycle safety analyses take a reactive approach to traffic safety by investigating crashes, injuries, or fatalities after they occur. Also examining trips that have been suppressed because of perceived road safety concerns facilitates a more proactive safety approach; however, a methodology must first be developed to estimate the number of pedestrian and bicycle trips that are suppressed specifically due to road safety concerns. To accomplish this, we examine child pedestrian and bicycle trips to and from schools in Denver, Colorado. By combining suppression rates derived from a survey examining parental perceptions of safety and the upper limit of trip frequencies derived from a GIS network analysis, we explore how grade level, gender, and adult supervision are related to childhood travel allowance in terms of street-level design characteristics such as posted speed limits, vehicle volumes, presence of sidewalks and bike lanes, and the number of vehicle lanes. We then investigate how widespread these suppressed trips are by quantifying the number of children that are impacted and how their routes are altered. Finally, we detect built environment characteristics – such as street-level designs, network configurations, barriers, and destination siting – linked with high levels of suppressed trips. By integrating this tool with traditional traffic safety analyses, we hope to not only make the places where children are currently walking and bicycling safer, but to improve safety in places where children should walk and bike.

Inventory of child bicycle education programs reveals need for age, development, and skill-level considerations

Objective: There are a plethora of child bicycle safety education programs worldwide. However, the content and durations vary widely from program to program and no gold standard has been established. The main objective of this project was to create an inventory of youth bicycle safety education programs and their content, approaches, and age and developmental considerations.Methods: Methods used to gather program information included web and online database searches, extraction from personal lists, and a widely distributed online survey. A total of 89 programs met inclusion criteria and were reviewed (78 from the United States and 11 from other countries).Results: Over half (56.2%) of the included programs were not explicitly age specific, meaning that the content was not appropriately designated by age and developmental cut points. Many programs had target age groups, but these were often very wide age ranges (e.g., all elementary school–age children) resulting in content too advanced for the youngest children. Only 12.4% of included programs had published program evaluations and their scientific rigor varied widely. Main results from this inventory revealed a weak evidence base for program effectiveness due to lack of program evaluations. Results also highlighted a need for age, development, and skill-level considerations in youth bicycle education programs.Conclusions: This study provides a comprehensive list of program components and approaches that can be used as a foundation upon which child bicycle education standards can be evaluated and built, with the long-term goal of increased childhood safety.

The built environment and active transportation safety in children and youth: a study protocol

BackgroundActive transportation, such as walking and biking, is a healthy way for children to explore their environment and develop independence. However, children can be injured while walking and biking. Many cities make changes to the built environment (e.g., traffic calming features, separated bike lanes) to keep people safe. There is some research on how effective these changes are in preventing adult pedestrians and bicyclists from getting hurt, but very little research has been done to show how safe various environments are for children and youth. Our research program will study how features of the built environment affect whether children travel (e.g., to school) using active modes, and whether certain features increase or decrease their likelihood of injury.MethodsFirst, we will use a cross-sectional study design to estimate associations between objectively measured built environment and objectively measured active transportation to school among child elementary students. We will examine the associations between objectively measured built environment and child and youth pedestrian-motor vehicle collisions (MVCs) and bicyclist-MVCs. We will also use these data to determine the space-time distribution of pedestrian-MVCs and bicyclist-MVCs. Second, we will use a case-crossover design to compare the built environment characteristics of the site where child and youth bicyclists sustain emergency department reported injuries and two randomly selected sites (control sites) along the bicyclist’s route before the injury occurred. Third, to identify implementation strategies for built environment change at the municipal level to encourage active transportation we will conduct: 1) an environmental scan, 2) key informant interviews, 3) focus groups, and 4) a national survey to identify facilitators and barriers for implementing built environment change in municipalities. Finally, we will develop a built environment implementation toolkit to promote active transportation and prevent child pedestrian and bicyclist injuries.DiscussionThis program of research will identify the built environment associated with active transportation safety and form an evidence base from which municipalities can draw information to support change. Our team’s national scope will be invaluable in providing information regarding the variability in built environment characteristics and is vital to producing evidence-based recommendations that will increase safe active transportation.

Equity Analysis of Proactively- vs. Reactively-Identified Traffic Safety Issues

Traffic safety issues often impede bicyclist and pedestrian trips, preventing potential users from realizing the benefits of active transport. Traditional active transportation safety analyses, however, take a reactive approach to traffic safety, only accounting for people currently walking or bicycling by analyzing crashes, injuries, and fatalities. This begs the question: which populations are most affected by traffic safety issues neglected by traditional crash analyses? To answer this, we developed a tool to proactively measure perceived traffic safety issues. We focused on child pedestrian and bicycle trips to and from schools in Denver, Colorado by measuring the number of children that would encounter roads perceived as unsafe. We converted these perceptions into barriers in a geographic information system network analysis to estimate trip suppression and used that as a proactive indicator of traffic safety. We finally examined—reactively and proactively—the socio-demographics of those affected via linear regression models and bivariate choropleth mapping. Results of both analyses suggest that negative impacts are borne disproportionately by low-income, low-education, Hispanic, and black neighborhoods. Proactive analyses results identified perceived safety issues in north and northeast Denver neighborhoods neglected by reactive analyses results. Findings suggest the inequitable distribution of traffic safety issues identified in past crash-based literature is graver than conventional reactive analysis would lead one to believe. By incorporating the proactive tool into traditional traffic safety analyses, we hope to better define the places and people that could most benefit from traffic safety improvements, thereby more effectively facilitating the benefits of walking and biking.

Suppressed child pedestrian and bicycle trips as an indicator of safety: Adopting a proactive safety approach

Traditional pedestrian and bicyclist safety analyses typically examine crashes, injuries, or fatalities. However, this reactive approach only accounts for the places where people are currently walking or biking and those that are doing so. Would a proactive approach – examining areas where pedestrian and bicyclist activity is being suppressed because of safety concerns – illuminate other previously neglected safety issues?The goal of this work is to compare results from reactive and proactive pedestrian and bicyclist safety analyses. To accomplish this, we focus on child pedestrians and bicyclists in Denver, Colorado because of the structured characteristics of their travel behavior regarding trips to school. We complete a reactive crash cluster analysis and a proactive safety analysis that is based on trip suppression due to traffic safety concerns. A parental perception survey informs the mode choice model we create for the proactive safety analysis.Findings suggest that reactive approaches identify downtown Denver and major corridors as unsafe, while the proactive analysis also identifies neighborhoods in west, east, and northeast Denver. Due to an absence of crashes, the majority of these areas would not normally be considered unsafe for pedestrians and bicyclists based on conventional reactive approaches. The fact that they are perceived as unsafe may be limiting usage and thereby limiting the number of crashes. In order to improve safety where children are currently walking and bicycling – as well as where they want to walk or bike – traditional analyses would benefit from augmentation by such a proactive safety approach.

Child Bicyclist Perspectives on Danger and Injury Circumstances in the Built Environment

Danger perception and the built environment are associated with injury risk in adult bicyclists, but limited research exists related to child bicyclists. Our pilot study describes child bicyclist perspectives on safety in the built environment. Participants were children who came to the Alberta Children's Hospital emergency department with a bicycling injury sustained on public property. Research team members interviewed participants about their injury circumstances (n=26). This research is based on thematic analysis of their responses to the open-ended interview questions. The risks children perceived were obstructions, debris, grade, visibility, and risky behavior. Fear of perceived danger in the environment influenced participants' bicycling experiences. The results inform child-contextual understanding of the built environment.

A randomized controlled field trial of iBsafe-a novel child safety game app.

Injury is a leading cause of child morbidity and mortality worldwide. Delivering injury prevention programs via mobile platforms, such as applications (apps), may reduce risky behaviors. iBsafe is an "interactive Bike and Bite safety" mobile game app founded in behavioral theory and designed to educate kindergarten-aged children about bicycle and dog-related safety. This study assessed the relationship of iBsafe game play and child safety knowledge and skills; hypothesizing that iBsafe increases safety knowledge with translation to practice. This single-blinded, randomized, controlled field trial included sixty 5-6-year-old children. Parent-child dyads were randomly assigned to receive a weeklong field trial of iBsafe or control. Pre- and post-intervention safety knowledge tests were completed; post-intervention safety skills assessments occurred in a simulated safety lab using real props (i.e., safety street, bicycles, and live dogs). The primary outcome was child bicycle and dog-related safety knowledge and skills performance. Performance was assessed by blinded reviewers. Secondary outcomes included frequency of safety discussion in groups and iBsafe acceptability. Thirty children were randomized to each group; there were no substantial demographic differences between groups. Compared to controls, post-intervention iBsafe children had higher bicycle and dog-related safety knowledge scores (9.2±0.9 vs. 8.7±1.0, P=0.029 and 8.2±2.1 vs. 6.7±1.8, P=0.003, respectively); and they exhibited more safety skills (median number bicycle skills 5 vs. 4, P=0.007; median number dog-related skills 5 vs. 3, P<0.001, respectively). Frequency of safety conversations increased among intervention families during the trial, and iBsafe acceptability was near universal. iBsafe was effective at increasing child safety knowledge and improving safety skills. Child injury prevention programs that embrace interactive mobile platforms may expand reach and possibly decrease injury outcomes.

Influence of collision site on head injury in crossing accident of child bicycle

Influence of collision site on head injury in crossing accident of child bicycle

Surgical outcomes of pancreaticoduodenal injuries in children

To examine surgical outcomes of children with pancreaticoduodenal injuries at a Quaternary Level I pediatric trauma center. We queried a prospectively maintained trauma database of a level one pediatric trauma center for all cases of pancreatic and/or duodenal injury from 2002 to 2017. Analysis was conducted using JMP 13.1.0. 170 children presented with pancreatic and/or duodenal injury. 13 (7.7%) suffered a combined injury and this group forms the basis for this report with mean ISS of 22.8 (± 15.1), RTS2 of 6.4(± 2.1), and median age of 6.6 (1.3-13.5) years. Child abuse (31%) and bicycle injuries (23%) were the most common mechanisms. 8/13 (61.5%) required operative intervention. Higher AAST pancreatic and duodenal injury grade (2.9 vs. 1.2, p = 0.05 and 3.6 vs. 1.4, p = < 0.01), lower RTS2 (7.84 vs. 5.49, p < 0.01), and lower GCS (9.6 vs. 15, p = 0.03) predicted operative intervention. 6/8 (75%) undergoing surgery survived to discharge with only (2/6) survivors suffering postoperative complications. Both mortalities were secondary to severe traumatic brain injury. Surgical management of complex pancreaticoduodenal injury is an uncommon traumatic event that is associated with high injury severity, but survival occurs in most scenarios.

The efficacy of a brief hazard perception interventional program for child bicyclists to improve perceptive standards

IntroductionEven though child bicyclists are highly vulnerable in traffic only few studies focused on providing child bicyclists with means to enhance their abilities to deal with the complexity of dynamic traffic situations. The current study therefore evaluated whether a brief hazard perception intervention might be effective to improve hazard perception skills in child bicyclists towards a level more comparable to adult bicyclists. MethodsEighty children of the fourth grade (9.03 ± 0.43 years; 34 girls) and forty-six adults (34.67 ± 14.25 years age; 24 woman) first performed a Hazard Perception test for bicyclists. Response rate, reaction times, first fixation, duration of the first fixation, dwell time and total number of fixations on the events were measured. Next, the children took part in the HP intervention in which video clips of dangerous traffic situations were presented. The intervention comprised two classroom sessions of one hour (1/week). A post-test was performed one day after and the retention-test three weeks after the intervention. ResultsChildren responded to more covert hazards immediately after the intervention (p < 0.05), but did not improve their response rate for overt hazards. Reaction times for the covert hazards improved on the post-test (p < 0.001) compared to the pre-test but this effect was reduced on the retention test. There was no effect of the intervention for entry time of the first fixation but the duration of the first fixation increased for the covert hazards (p < 0.05). Children made fewer fixations on the event compared to adults (p < 0.001), except for the covert hazards on the retention-test. The training also increased the number of fixations for the overt hazards on the post-test (p < 0.001) and the retention-test (p < 0.001) but only increased on the retention test for the covert hazards (p < 0.001). ConclusionThe results demonstrated that a brief intervention for training hazard perception skills in child bicyclists is able to improve children’s situation awareness and hazard perception for potential dangerous situations. The training, however, was too short to improve children to higher adult levels.

Hazard perception training in young bicyclists improves early detection of risk: A cluster-randomized controlled trial

IntroductionSince child bicyclists are more likely to get involved in a traffic crash, there is a stringent need to provide child bicyclists with tailored interventions in order to enhance their capabilities to deal with the complexity of traffic situations. The current study therefore aimed to test the effectiveness of a hazard anticipation training in young bicyclists by means of eye tracking technology. MethodsA cluster-randomized controlled design was used in which participating schools were randomly assigned to the intervention or the control group. At first, a baseline hazard anticipation test was carried out in the intervention group (78 children; 9.56±0.38years of age) and the control group (46 children; 9.58±0.41years of age). Child bicyclists who participated in the intervention followed the training that consisted of two classroom sessions. In each session children were presented with video clips from the perspective of a bicyclist encountering various (potentially) dangerous traffic situations. Following the intervention, a post-test directly after the training and a retention test three weeks later were completed. The control group received the intervention after the retention test. ResultsTrained child bicyclists were found to detect more hazards and reacted quicker compared to the control group that did not receive the training. However, the training did not result in improvements in anticipatory visual search behaviour. ConclusionTrained child bicyclists seemed to have developed a better processing regarding potential dangerous situations but were not able to ‘see’ the hazard sooner. The potential of a brief hazard anticipation training is discussed.

Examination of adult and child bicyclist safety-relevant events using naturalistic bicycling methodology

Among roadway users, bicyclists are considered vulnerable due to their high risk for injury when involved in a crash. Little is known about the circumstances leading to near crashes, crashes, and related injuries or how these vary by age and gender. The purpose of this study was to examine the rates and characteristics of safety-relevant events (crashes, near crashes, errors, and traffic violations) among adult and child bicyclists. Bicyclist trips were captured using Pedal Portal, a data acquisition and coding system which includes a GPS-enabled video camera and graphical user interface. A total of 179 safety-relevant events were manually coded from trip videos. Overall, child errors and traffic violations occurred at a rate of 1.9 per 100min of riding, compared to 6.3 for adults. However, children rode on the sidewalk 56.4% of the time, compared with 12.7% for adults. For both adults and children, the highest safety-relevant event rates occurred on paved roadways with no bicycle facilities present (Adults=8.6 and Children=7.2, per 100min of riding). Our study, the first naturalistic study to compare safety-relevant events among adults and children, indicates large variation in riding behavior and exposure between child and adult bicyclists. The majority of identified events were traffic violations and we were not able to code all risk-relevant data (e.g., subtle avoidance behaviors, failure to check for traffic, probability of collision). Future naturalistic cycling studies would benefit from enhanced instrumentation (e.g., additional camera views) and coding protocols able to fill these gaps.

Bicycle helmet use among persons 5 years and older in the United States, 2012

IntroductionIn 2013, injuries to bicyclists accounted for 925 fatalities and 493,884 nonfatal, emergency department-treated injuries in the United States. Bicyclist deaths increased by 19% from 2010 to 2013. The greatest risk of death and disability to bicyclists is head injuries. The objective of this study was to provide estimates of prevalence and associated factors of bicycle riding and helmet use among children and adults in the United States. MethodCDC analyzed self-reported data from the 2012 Summer ConsumerStyles survey. Adult respondents (18+years) were asked about bicycle riding and helmet use in the last 30days for themselves and their children (5 to 17years). For bicycle riders, CDC estimated the prevalence of helmet use and conducted multivariable regression analyses to identify factors associated with helmet use. ResultsAmong adults, 21% rode bicycles within the past 30days and 29% always wore helmets. Respondents reported that, of the 61% of children who rode bicycles within the past 30days, 42% always wore helmets. Children were more likely to always wear helmets (90%) when their adult respondents always wore helmets than when their adult respondents did not always wear helmets (38%). Children who lived in states with a child bicycle helmet law were more likely to always wear helmets (47%) than those in states without a law (39%). ConclusionsDespite the fact that bicycle helmets are highly effective at reducing the risk for head injuries, including severe brain injuries and death, less than half of children and adults always wore bicycle helmets while riding. Practical applicationStates and communities should consider interventions that improve the safety of riding such as policies to promote helmet use, modeling of helmet wearing by adults, and focusing on high risk groups, including Hispanic cyclists, occasional riders, adults, and children ages 10 to 14.