CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 1

Transcription

1 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 1 Child Pedestrian Accidents in San Diego Neighborhoods Colin T. Stowell San Diego Fire-Rescue Department San Diego, California

2 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 2 Certification Statement I hereby certify that this paper constitutes my own product, that where the language of others is set forth, quotation marks so indicate, and that appropriate credit is given where I have used the language, ideas, expressions, or writings of another. Signed:

3 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 3 Abstract The rate of pedestrian accidents involving children varies widely across communities in the City of San Diego. Identifying the community characteristics associated with an elevated risk of this type of victimization is essential in developing strategies to improve pedestrian safety. There is a disproportionately higher rate of pedestrian accidents involving children in certain neighborhoods as compared to others in the City of San Diego. The purpose of this research project was to identify and examine the communities in San Diego that experience a higher number of pedestrian accidents involving children. The research questions addressed by this project were: (a) Which communities in San Diego experience a disproportionately high number of such accidents involving children? (b) What factors influence the risk of pedestrian accidents for children in certain communities? (c) Are there differences in the safety awareness and walking practices of children in communities with higher accident rates as compared to communities with lower rates? (d) Are there disparities in pedestrian safety programs available to children across communities? To address these questions, this study employed a series of descriptive research methodologies; retrospective analysis of accident reports, review of current safety programs, surveys of comparable fire departments, interviews with safety and school administrators, student surveys, and systematic observations of juvenile walking behaviors. The results suggest that the levels of pedestrian accidents are linked to a series of community structural and demographic characteristics. Indeed, at highest risk for pedestrian accidents are minority children residing in socioeconomically distressed neighborhoods. Recommendations included (a) development of strategies to reduce pedestrian risk in identified neighborhoods, (b) parental participation in the assessment of pedestrian hazards in neighborhoods, (c) increased funding of pedestrian training programs, and (d) additional neighborhood traffic enforcement.

4 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 4 Table of Contents Certification Statement 2 Abstract 3 Table of Contents 4 Introduction 5 Background and Significance 6 Literature Review 9 Procedures 17 Results 23 Discussion 36 Recommendations 40 References 43 Appendix A: Distribution of Pedestrian Accidents in San Diego, Appendix B: Demographics of Southeastern and Del Mar/Mira Mesa SRA 48 Appendix C: Interview Questions for Safe Kids Program Coordinator 52 Appendix D: Interview Questions for School Principals 53 Appendix E: Pedestrian Safety Quiz 54 Appendix F: Observational Survey Tally Sheet 56 Appendix G: Survey on Child Pedestrian Safety 57

5 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 5 Child Pedestrian Accidents in San Diego Neighborhoods It is widely acknowledged by emergency responders and community risk professionals that certain neighborhoods in the City of San Diego have a higher rate of pediatric pedestrian accidents as compared to other neighborhoods. What is not known are which specific communities experience this higher rate and factors that contribute to this elevated risk level. Although many assumptions can be made as to why some communities are affected by pedestrian accidents more than others, an analysis of the demographic and socioeconomic differences of those communities, while considering the engineering and environmental factors in those neighborhoods, is needed to understand better the issues that contribute to higher occurrences of such accidents. Pediatric pedestrian emergencies result in not only a financial burden to the families of the victims; they also carry significant emotional and psychological impacts to family, emergency responders, and the community as a whole. The problem is a disproportionately higher rate of pedestrian emergency incidents involving children 5 to 11 years in certain neighborhoods as compared to other communities in the City of San Diego. The purpose of this research project is to address the gap in knowledge regarding an important public and community health problem. Specifically, this research will identify which communities experience a higher number of pedestrian accidents involving children between the ages of 5 to11 years and to examine the environmental and behavioral factors that influence these higher numbers as compared to other communities in the City of San Diego. This project used a descriptive research methodology through retrospective analysis of pediatric pedestrian accident reports, a review of current educational programs related to pedestrian safety, surveys from other fire departments, and personal interviews with safety coalition and school administrators. Written tests and observational surveys were also used to assess elementary school student s

6 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 6 knowledge of pedestrian safety and walking behaviors. The research questions to be investigated by this project are: (a) Using retrospective analysis of emergency incident data, which communities have a disproportionately high number of pedestrian emergency incidents involving children 5 to 11 years in the City of San Diego? (b) What risk factors and behaviors influence or are responsible for the higher number of pedestrian emergency incidents in certain communities? (c) What is the awareness level and understanding of children 5 to 11 years related to safe walking practices and pedestrian rules in communities with higher numbers of pedestrian emergency incidents as compared to other communities? (d) What formal or informal pedestrian safety programs are in place for children in communities with higher numbers of pedestrian emergency incidents as compared to other communities? Background and Significance Every year approximately 39,000 children are injured and 630 killed from being struck by vehicles in the United States (Centers for Disease Control and Prevention, 2011). Further, nearly one in four traffic deaths among children under the age of 14 are pedestrian related. Although pedestrian death rates continue to decline, pediatric pedestrian injury still ranks among the most serious causes of unintentional childhood injuries and deaths. In 2005, the total lifetime costs associated with motor vehicle-pedestrian injuries and death among children less than 14 years of age was approximately $711 million, with $566 million attributed to hospitalization as a result of pedestrian injuries (Safe Kids Gainesville Hall, 2005). Previous studies have shown that the risk for such accidents vary, with children, older adults, and the lower socioeconomic population are most susceptible to pedestrian collisions (Chakravarthy, Anderson, Ludlow, Lotfipour, & Vaca, 2010). With respect to minors, factors such as developing sensory and cognitive skills, impulsivity, and poor parental supervision contribute to the higher frequency of

7 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 7 accidents affecting this population (American Academy of Pediatrics, 2009). According to the most recent data available in the California Statewide Integrated Traffic Records System (SWITRS) there were 105 children injured or killed while walking in the City of San Diego from (Statewide Integrated Traffic Records System-Annual report, 2010). Nationally, pedestrian related deaths involving children between the ages of 5-9 years ranks seventh among the leading causes of unintentional injury deaths (Centers for Disease Control and Prevention, 2011). Evidence suggests that such accidents pose a somewhat bigger health threat in San Diego County where child pedestrian deaths ranks second only behind deaths associated with being an occupant in a motor vehicle accident (Causes of unintentional injury, 2009). Although an important safety concern, competing funding priorities have eliminated most pedestrian safety education programs available through the school district in San Diego. The decreasing number of available programs has left a void that is only partially filled by federal and state funded programs such as Safe Routes to School (SRTS) in addition to some voluntary public safety presentations initiated by active Parent Teacher Association (PTA) groups (M. Moran, personal communication, November 15, 2013). According to Mary Beth Moran with the San Diego County Safe Kids Coalition (2013), funding from SRTS has been successful with making traffic engineering changes and implementing enforcement strategies in some of the high risk neighborhoods, but the coalition recognizes that childhood pedestrian injuries continue to be prevalent and disproportionately affect children in these crowded and lower income areas. Research indicates that children in lower income, densely populated, urban residential areas are more vulnerable to pedestrian related injury with some reports citing children in lower income neighborhoods being as much as 5.7 times more likely to be injured as pedestrians (American Academy of Pediatrics, 2009).

8 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 8 San Diego Fire-Rescue Department (SDFD) provides fire protection and emergency medical services to more than 1.3 million people covering 331square miles comprising of 52 recognized communities (City of San Diego, 2013). In Fiscal Year 2013 (FY2013) the department responded to 129,221 emergency incidents, of which 87% were medical responses (FY2013 Annual Report, 2013). In 2012, SDFD responded to 412 incidents involving pedestrian emergencies of which 32 involved children between the ages of 5-11 years. Although the number pediatric pedestrian emergency incidents are statistically a small share of the total number of incidents citywide, the disproportionate concentration in certain communities is significant and cause for concern. Even with a budget of just over $200 million for FY2014, SDFD does not have a dedicated Community Risk Reduction Officer within the organization to work with high risk populations to improve safety awareness and practices. The disproportionate number of pediatric pedestrian emergency incidents in certain neighborhoods is significant to the City of San Diego and SDFD because it suggests that there may be a combination of underlying environmental, social, and behavioral factors that contribute to the elevated risk in these areas. Higher numbers of pediatric pedestrian emergencies affecting these neighborhoods result in unnecessary financial costs and emotional distress related to medical care of victims and that suffered by the families. Beyond its value to SDFD, the results from this research may also be of use to several public agencies including San Diego County Health and Human Services Agency and the Safe Kids Coalition which serve as the agencies that manage grant funding and public programs aimed at improving the safety of children. This research paper is relevant to several objectives listed in Units 1 and 2 of the Executive Analysis of Community Risk Reduction curriculum related to comparing and contrasting community risk, the levels of risk prevention, and assessing the hazards and casual

9 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 9 factors in one s community (Executive Analysis of Community Risk Reduction Student Manual, 2012, Units 1 & 2). These units explain the role of the Executive Fire Officer (EFO) in identifying community risk and the potential impacts if those risks are not addressed, while also stressing the importance of recognizing both the challenges and benefits associated with reducing the community risk. The analysis which was developed in this applied research paper (ARP) align with the activities listed under Step II of the Community Risk-Reduction Model (Executive Analysis of Community Risk Reduction Student Manual, 2012, p. 1-8) and would be considered a Secondary Prevention level designed to mitigate or modify events to reduce the severity of occurrence affecting a high risk population (p. 12). This ARP also relates to the United States Fire Administration (2010) first strategic goal to Reduce risk at the local level through prevention and mitigation (United States Fire Administration Strategic Goals, 2010, p. 14) and is specifically applicable to the operational initiative to expand public fire and safety education through various avenues to all segments of the population, especially those at high risk (p. 18). Literature Review The following literature review focused on four distinct areas: (a) studies related to the demographics of neighborhoods and populations with higher rates of pedestrian injuries and death, (b) risk factors that contribute to higher rates of pediatric pedestrian accidents, (c) behavior and emotional factors that influence the frequency of child pedestrian accidents, and (d) the effectiveness of existing programs and available funding for child pedestrian safety. The exposure to traffic appears to be a straightforward cause and effect of a child pedestrian accident. However, such perceptions greatly oversimplify the true nature of such incidents. Indeed, pedestrian accidents are generally complex events which are the result of the

10 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 10 confluence of many contributing factors such as pedestrian and driver behavior, weather, lighting, vehicle and traffic engineering, and the presence of other distractions. Such factors, particularly when combine with the impulsiveness of children, these accidents become even more complicated and unpredictable events. Therefore, these outcomes are best understood as resulting from a complex web of behavioral, social, and environmental conditions. Demographic characteristics of a child including age, sex, race/ethnicity, and the socioeconomic status of their community are the most consistent predictors of pedestrian injury and have been shown to disproportionately affect particular groups (Schieber & Vegega, 2002). An increased risk for pedestrian injuries occurs when certain social factors manifest in a dangerous environment. The primary social group for a child is their family. Some of the environmental factors that define a child s awareness of safety include; parental involvement, income level and highest level of education within the family unit. Family income often determines the neighborhood a child lives in, type of housing, dependency on walking, separation of play areas from traffic, and parental supervision. The highest level of education achieved by a parent often influences their life style, which in turn correlates with health related behaviors and accepted risk exposures of the family (Schieber & Vegega, 2002). The younger a child is, the more at risk they are for traffic related pedestrian injuries simply due to their limited awareness and unsafe behaviors. Age is also a big determinant of risk since it largely determines a child s independence and mobility. Since children under one year of age are dependent on their caretaker for mobility, they have far less exposure to traffic environments. As a child gets older, he/she becomes more mobile with less supervision and travels further independently. Risk dramatically increases as a child gets older and more mobile, and remains high through the age of six when it begins to decrease until the age of 11 (Winn &

11 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 11 Anderson, 2003). According to the Winn and Anderson 2003 report, for the period from there were more pedestrian injuries for children ages 1-7 years of age and more pedestrian related hospitalized children ages 1-10 than there were injuries due to being an occupant in a motor vehicle for those same age groups. Minorities experience an increased risk of being struck by a vehicle (Hilton, 2006). Race/ethnicity has been shown to play a significant role in pedestrian fatalities and injuries. National data show that minorities of all age groups have a higher rate of pedestrian fatalities than the non-hispanic white population (Hilton, 2006). Studies have also shown that minority groups are often underreported related to emergency incidents for various reasons such as cultural related attitudes, familiarization with emergency services, health care concerns, and a general skepticism of public agencies which would likely increase the disparity even more in pedestrian injury rates among minority populations (Sciortino, Vassar, Radetsky, & Knudson, 2005). Similar racial disparities also exist for California, where pedestrian injury rates are higher for African-American children (2.4 fatalities and 41.4 injuries per 100,000 annually) and for Hispanic children (2.0 and 25.4 per 100,000) than for white children (1.4 and 13.2 per 100,000) (Winn & Anderson, 2003). San Diego County data for 2010 mirrors state statistics showing African Americans having the highest pedestrian injury and death rates followed by Hispanics. African Americans in San Diego are also over-represented among deaths, where they comprise 5% of the city s population yet account for 15% of pedestrian deaths (County of San Diego, Health and Human Services Agency, 2010). Boys are more likely than girls to be injured in a pedestrian accident which may be due to a difference in their exposure level and activities. Rather than being biologically predisposed to injury, boys may be more at risk as a result of different preconceived notions and beliefs that

12 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 12 they don t need to be as careful or supervised as closely as girls (Schieber & Vegega, 2002). What s considered acceptable behavior for a boy, the activities they frequently participate in, and their physical agility all appear to increase a boy s risk of pedestrian injury. Exceptional physical agility actually increases ones risk to being hit by a car, while physical limitations reduce the risk which most likely is due to mobility and decreased exposure respectively (Christoffel & Schofer, 1996). National data indicate that 64% of all children killed in 2010 while walking were male and the rate of pedestrian injury for boys was more than double the rate for girls (National Highway Traffic Safety Administration, 2010). California statistics reflect the same disparity between genders with boys having an injury rate of 27.9 per 100,000 as compared to girls with 14.8 per 100,000 (Winn & Anderson, 2003). Several socioeconomic status and demographic factors influence the risk of a pedestrian being struck by a vehicle such as highest level of parental education, proficiency in speaking and understanding English, ethnicity, and population density. However being a member of a low income family is the greatest predictor of pedestrian injury (Chakravarthy, Anderson, Ludlow, Lotfipour, & Vaca, 2010). According to Chakravarthy (2010) a child in Orange, California is nearly 9 times as likely to be a victim of a pedestrian accident in the poorest quartile of neighborhoods as they are in the wealthiest quartile. The study showed that although many socioeconomic factors contribute to the pedestrian risk of a child, a neighborhoods poverty rate alone results in the greatest disparity of pedestrian injuries. The environment plays a crucial role in the risk of child pedestrian accidents and is directly related to other factors such as social structural status of the community. Child pedestrian injuries are significantly more prevalent in urban neighborhoods, with 75% of all related accidents occurring in such settings and rates proportionate to population density

13 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 13 (Mazurek, 1994). Children of low income families tend to live in more dense, urban residential neighborhoods where they are at much greater risk of experiencing pedestrian injury. In part this may be due to the fact that urban neighborhoods have fewer designated play areas, increased traffic, and a higher number of cars parked on the street, all of which translate into increased risk to children living or playing in those neighborhoods (Schieber & Vegega, 2002). Moreover, children living in a multiple-family residence (most common in dense urban centers) have almost three times the risk of pedestrian injuries as compared to children living in a single-family detached residence (Jacobsen et al., 2000). Children are most likely to be struck by a motor vehicle on a residential street near their home with the most common cause being the pedestrian dart-out or dash where a child runs out into the road out of view of the motorist. This type of accident accounts for 43% of all pedestrian incidents involving 5-9 year olds (Pedestrian and Bicycle Information Center, ) and in 2010 more than 80% of child pedestrian deaths occurred at non-intersection locations (National Highway Traffic Safety Administration, 2010). Time of day is also seen as a significant factor in child pedestrian accidents, with the highest risk time between 3 and 7 PM during which 36% of fatalities occur (American Academy of Pediatrics, 2009). And although counterintuitive, the majority of pedestrian accidents occur under optimal driving conditions during daylight and dry road conditions (Nance, Hawkins, Vivarelli-O Neil, & Winston, 2004). According to the National Highway Traffic Safety Administration (NHTSA), the number of pedestrian fatalities decreased by 49% in children under 14 years during the ten year period of , with the greatest percent drop (57%) in the 4-7 age group (National Highway Traffic Safety Administration, 2007). Statistics on the number of kids who walk to school indicates this decrease is most likely a result of less walking and lower exposure to traffic. In 1969, 42% of all

14 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 14 schoolchildren and 89% of those living within a mile from school walked or rode their bicycle to and from school (US Department of Transportation, Federal Highway Administration, 1969). Recent statistics show only about 16% of schoolchildren walk or ride bicycles to school, with 37% of those living within one mile of school being driven to school (Centers for Disease Control and Prevention, 2008). Parent surveys conducted by the Centers for Disease Control and Prevention (2005) found that the major barriers preventing children from walking to school are distance (62%), traffic dangers (30%), weather (19%), and crime (12%). Behaviors, awareness levels, and parental beliefs place children at significant risk when exposed to traffic conditions and contribute tremendously to the occurrences of pedestrian accidents. Children lack the cognitive and behavioral abilities to negotiate traffic, understand the meaning of road signs, see cars in their peripheral vision, and have difficulty judging distances and speeds or anticipating driver behaviors (American Academy of Pediatrics, 2009). While children as young as nine years can learn the skills to cross streets safely, it is unlikely they will practice these skills regularly because of their cognitive and behavioral abilities when distracted or involved in play. The necessary cognitive skills and abilities to negotiate traffic are not fully developed until the age of 11 or 12 (Jacobsen et al., 2000). Many parents are not aware of these developmental limitations and tend to overestimate their child s ability to be safe in traffic situations as a pedestrian. Adult supervision and role modeling is critically important to engraining successful and safe pedestrian behaviors in children. Unfortunately, not only do parents overestimate their child s ability to act safely in traffic, they themselves lack basic knowledge about pedestrian injury and do not adequately teach children about road safety (American Academy of Pediatrics, 2009, p. 4).

15 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 15 Research first began on child pedestrian safety in the 1970 s and received national attention with the Department of Transportation (DOT) publication of School Trip Safety and Urban Play Areas in The first modern Safe Routes to School (SRTS) program in the US began in the Bronx, NY in 1997 which funded pedestrian safety improvement projects and education. The following year Congress funded two pilot programs in California and Massachusetts, and then in 2005 passed federal legislation to establish the National SRTS program which has apportioned nearly $1.5 billion to states as of September 2012 to be used for school zone infrastructure projects or other related safety initiatives (National Center for Safe Routes to School, 2013). Currently all 50 states operate SRTS programs benefiting over 15,000 schools. The California Department of Transportation (Caltrans) SRTS construction program was the first state legislative effort to direct federal highway traffic safety funds towards child pedestrian safety. The program directs $20 to $25 million annually to traffic related child pedestrian safety improvement projects. San Diego Safe Kids Coalition is the local chapter with Safe Kids Worldwide and one of 600 coalitions worldwide that partner together with communities to provide families the education, resources, and expertise to keep kids safe. Safe Kids of San Diego coordinates with state and federal SRTS programs to conduct school site traffic assessments referred to as walk audits with a goal to identify and modify traffic flow patterns, provide child and parental safety education materials, partner with high risk schools to create safety plans, and make traffic engineering and enforcement recommendations (M. Moran, personal communication, November 15, 2013). Safe Kids has established a five step process aimed at improving the safety of children walking known as the five E s : evaluation, encouragement, education, enforcement, and engineering (M. Moran, personal communication,

16 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 16 November 15, 2013). A combination of these interventions is needed to be effective at increasing the safety of pedestrian children. Education and enforcement alone have shown limited effectiveness without street modifications and reduced traffic speed in high risk neighborhoods. Because of their limited abilities and judgment, society cannot adapt children to traffic; society has to adapt traffic to children (Jacobsen et al., 2000, p. 74). No randomized clinical trial has demonstrated that traffic safety educational programs reduce the rate of pediatric injuries, however reviews of skills-training programs have shown to improve attitudes, knowledge, and behaviors related to crossing the street (American Academy of Pediatrics, 2009). Whether existing educational programs substantially improve the behaviors of children in traffic conditions continues to be a topic of debate. Most studies have failed to show support for classroom educational programs aimed at simply increasing a child s knowledge and awareness of traffic safety (Schieber & Vegega, 2002). One study done by Livingston, Suber, Clancy, Passannante, & Lavery (2011) examined long term effectiveness of a one-time annual pedestrian safety program (WalkSafe) delivered through the schools. It found that although short and immediate term knowledge gains were seen in all ages, scores for younger children regressed to baseline knowledge levels within one year. These types of programs assume that by improving a child s knowledge of traffic dangers and encouraging their attitudes and behaviors related to safety, the child will apply this learned information to real life traffic situations for a relatively short period. Rather than simply focusing on improving the level of knowledge that may only influence how children might answer questions about road safety, studies recommend that other strategies be employed to supplement this academic foundation. Practical skills training methods demonstrated and reinforced in a variety of traffic situations lead to behavioral changes in

17 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 17 children and improved ability to navigate safely in traffic. Safety programs in which education was one component of a broader program including parental education, police enforcement of traffic laws, engineering and construction projects, and legislative changes have been successful in significantly reducing child pedestrian injury rates (American Academy of Pediatrics, 2009). Most safety training programs occur through the schools, however parent participation as trainers or role models is important and their involvement may add to the success of changing a child s behavior. A review of pedestrian safety programs for children concluded that effective solutions to the problem should be multifaceted involving experts from diverse fields of child development, traffic engineering, public health and safety agencies, legislators, and need to include strategies aimed at teaching adults the normal capabilities and vulnerabilities of children in different demographic groups (Schieber & Vegega, 2002). Procedures Methodology Several procedures were employed to examine the questions of central importance to this research study. Electronic surveys, personal interviews, review of state and local data on pedestrian accidents, and an analysis of incident reports for pedestrian injuries and deaths in the City of San Diego was conducted. Data showing current and historical trends provided quantitative perspective on the issue. The use of geographical information systems (GIS) software provided valuable information regarding the spatial distribution of incidents, which was used in the selection of comparative research sites across the city. Because of the low frequency of pedestrian injuries and death involving children between the ages of 5-11 years, the data analyzed in this paper was pooled over the four year period of This approach was used in an effort to minimize annual fluctuations in certain

18 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 18 neighborhoods that experienced pedestrian accidents isolated to a short time period. Thus, pooling these data has a stabilized effect and is more reflective of the actual trends in pedestrian accidents between neighborhoods. The analysis period of also allowed for comparison of San Diego County and SDFD statistics to the most current data available through the state reporting system, SWITRS. Data for pedestrian incidents involving children ages 5-11 years from occurring in the City of San Diego was obtained through the SWITRS and geocoded using Transportation Injury Mapping System (TIMS) in order to analyze the geographic distribution of incidents and identify neighborhoods for study (Appendix A). Patient Care Reports (PCR) completed by emergency responders for all pedestrian patients between 5 to 11 years of age were used as a secondary data source to support and compare against SWITRS. PCR data was determined to be more reliable than the dispatch type data due to the inaccurate and incomplete patient and location information typically obtained at the time of the initial report to 911. A PCR is completed for all patient encounters and provided much cleaner data when looking at incident types, patient information, and incident location. The SWITRS and PCR data were analyzed for aggregate statistics, patient demographics, and locations. Two neighborhoods were selected as the study areas for this paper, one from an area that experienced a high number of pedestrian accidents, and from an area that experienced a low number. These neighborhoods were grouped with their respective census tract Subregional Area (SRA) and used for comparing the aggregate pedestrian incident data and a comprehensive demographic profile of those two SRA s. In addition to including a larger share of pedestrian accidents, the SRA was used as the primary unit of analysis because they provided a more comprehensive overview of the

19 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 19 demographic characteristics in areas experiencing highest and lowest number of pedestrian accidents (Appendix B). One elementary school proximate to the majority of the pedestrian accidents within each of the two identified SRA s for study was selected for sample student assessments and observational behavior surveys. Initial contact was made with the principals of the identified schools and to ascertain willingness to participate and receive the support of school staff. Personal interviews (Appendix C and D) were conducted with the county s Safe Kids program coordinator and the principals of each school. The objective of the interviews was to gather historical information on safety programs, informal or formal education programs available to students, perceived environmental safety issues particular to those school sites, existing traffic engineering concerns or recent project improvements related to pedestrian or traffic safety, and their opinions on improving the effectiveness of pedestrian safety programs. The author also participated, along with many public agencies, in one of the Walk Audits with the SRTS program at a local school to experience how environmental and infrastructural projects related to pedestrian safety are evaluated and recommended for improvement using grant funds. A written multiple choice test (Appendix E) was developed using national pedestrian safety curriculum and administered to the fifth grade students at both elementary schools. Fifth grade students were selected as the target study group due to their ability to better comprehend the test material with limited interpretation or examples required. In addition, this group appeared to be of central importance, as a preliminary data review indicated that 11 year olds had the highest percentage of pedestrian accidents within the age group and time under investigation. Test results were used to compare baseline knowledge of pedestrian traffic safety between the two student populations of the same school district having the same access to a formal

20 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 20 curriculum related to pedestrian safety. The surveys were also used to assess students on their method of transportation to and from school, parental involvement in teaching of safe walking practices, role modeling, and adult supervision while walking in traffic. Observational surveys were conducted in traffic areas adjacent to both elementary schools using multiple surveyors at different routes to and from the school. Surveyors used tally sheets (Appendix F) to record aggregate occurrences of unsafe walking behaviors according to a set of predetermined data points which evaluated the walking practices of that school s population. Although many types of unsafe behaviors, besides those related to walking, were observed, only the predetermined unsafe pedestrian practices were counted for comparative purposes. Observational data were collected on two separate days for 40 minutes at each site (20 minutes before and 20 minutes after school). A survey (Appendix G) was developed to solicit information on pedestrian safety programs in other fire jurisdictions and the level of involvement those departments may have in such programs. The survey also asked questions relating to perceptions of disproportionate pedestrian injury and death rates affecting certain neighborhoods within those jurisdictions and whether any research on the topic had been conducted in those locations. The survey was administered electronically to enhance the ease of distribution and the convenience of the respondents. The survey was comprised of a series of closed- ended questions in an effort to compile the results more accurately. The survey instrument was developed by the author and reviewed by SDFD chief officers. The survey was distributed via to most paid career fire departments in California using the California Professional Firefighters (CPF) directory, distribution groups provided by the SDFD Assistant Fire Chief for departments not included in the previous group, as well as the author s contacts from previously attended courses at the

21 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 21 National Fire Academy for a total of 145 surveys distributed utilizing the service of Survey Monkey ( The survey population was selected from paid career departments to evaluate what level their operational time or budget was allocated to safety programs. Career departments also provided information about their standardization for incident reports, obligation to the community programs, and labor issues that may affect involvement in pedestrian safety programs. Limitations and Assumptions It was assumed that the census data and 2010 Demographic Profile of the SRA was reflective of the neighborhoods identified for this study. This paper focused on children ages 5-11, and the incident and patient data reviewed was collected by first responders, law enforcement, and hospital staff pertaining to the victim and not the family. For this reason, it was assumed that the children involved in the study resided in the community in which the accident occurred. Therefore, the justification of demographics and social structural risk factors of the incident may not always correspond to the residential characteristics of the community in which the victim actually resides. Personal interviews involving impressions in regards to the effectiveness of pedestrian safety measures and the level of adult supervision are subjective. Individual understandings or beliefs of the factors influencing pedestrian behavior may be biased and unsupported by research or observational data. The incident data included children ages 5-11 years; however due to the time constraints and complexities of developing multiple tests for all grade levels, only fifth grade students were surveyed. Similarly, although multiple elementary schools were located within the SRA s selected for study, this paper limited the administration of written tests and observational surveys

22 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 22 to only one school from each identified SRA. It was assumed that students taking the written tests were able to read and comprehend the questions being asked regarding pedestrian safety, and they responded honestly to questions related to parental involvement and demonstration of safe walking behaviors. The assumption was also made that students from a school with lower academic performance and/or English as a second language (ESL) students would most likely not do as well on the written exam. Observational surveys were limited to selected routes to and from the schools which may not have accounted for all student s pedestrian travels or behaviors. The electronic survey distribution was limited to paid career departments without any knowledge of their budgetary constraints, department involvement in community risk reduction programs, existing safety programs for children, or significance of child pedestrian death and injury rates in their community. Demographics of the communities each department serves varies significantly and may not align with the demographics or socioeconomic factors observed in San Diego. It is assumed that all survey respondents and persons interviewed answered all the questions honestly, to the best of their ability, and had adequate knowledge of their department s involvement and the availability of safety programs for children living in that community. Limitations included the willingness and response of other departments to complete the survey. Definitions Patient Care Report (PCR). Official department reports by first responders and ambulance personnel documenting incident information including patient findings, treatment, and disposition. Rate. Occurrences of an incident per 100,000 population.

23 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 23 Safe Routes to School (SRTS). National safety program providing state and local grant funds dedicated to research, education, and engineering improvements related to child pedestrian safety. Subregional Area (SRA). An aggregation of census tracts in a defined area and identified by the US Census Bureau. Statewide Integrated Traffic Reporting System (SWITRS). A database used in California as a means to collect and process data gathered from collision scenes by law enforcement agencies. Transportation Inquiry Mapping System (TIMS). A data and mapping analysis tool offered through the University of California, Berkeley which uses SWITRS data to provide information for traffic related safety research and planning. Walk Audit. On-site inspection coordinated by the SRTS program at schools seen as high risk for pedestrian accidents aimed at identifying pedestrian safety issues and prioritizing improvement projects funded through SRTS grants. Results For the years under investigation, again , there were 105 children between the ages of 5-11 years struck by vehicle. SDFD PCR data showed slightly higher numbers with 113 incidents for the same period and age range, but included some patient encounters significantly after the time of the accident and at different locations than where the accident occurred. The eight incident discrepancies did not provide enough details on the accident locations or causes to be validated for this report and subsequently were excluded. Table 1 shows the number of pedestrian versus motor vehicle accidents by individual SRA, with just three of the 11 SRA s in San Diego accounting for 77 (73.4%) of the 105 pedestrian incidents. The Central San Diego, Mid-City, and Southeastern San Diego SRA s experienced significantly higher numbers of

24 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 24 pediatric pedestrian injuries and deaths as compared to other SRA s during the four year period, with the Southeastern San Diego SRA recording the highest number of accidents with 31 (29.5%). Based on the numbers of incidents for each SRA and comparing two SRA s with similar population numbers and geographic area, the Southeastern San Diego and Del Mar/Mira Mesa SRA s we identified as the two study groups for demographic comparison, observational survey, and student evaluations. Although the Del Mar-Mira Mesa SRA did not experience the lowest number of pediatric pedestrian accidents, it was selected for study due to the similarities it had with the Southeastern SRA in geography, types of residential units, population size and diversity. Table 1. Distribution of Pedestrian Accidents Involving Children Ages 5-11 by Subregional Area (SRA), San Diego, Subregional Area (SRA) # of Total Victims % of Total Victims Central San Diego % Coastal 3 2.9% Del Mar-Mira Mesa 6 5.7% Elliott-Navajo 3 2.9% Kearny Mesa 5 4.8% Mid-City % Peninsula 1 1.0% Poway 1 1.0% South Bay 8 7.6% Southeastern San Diego % University 1 1.0% Grand Total % Data Source: Statewide Integrated Traffic Reporting System (SWITRS), accessed 12/2013 from Transportation Injury Mapping System ( PCR data were collected by postal zip codes rather than by census tract, but showed similar geographic disparity in the number of incidents, with just two of the 32 zip codes within

25 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 25 the city accounting for 23% of the pedestrian accidents involving children 5-11 years of age. The two zip codes with the highest levels of pedestrian accidents include the Southeastern and Central San Diego SRA s, as identified through SWITRS. Figure 1 shows the official causes of the pedestrian accidents involving the target population. According to SWITRS, violations by the pedestrian child were the cause for 59% of the accidents followed by drivers failing to yield the right of way for the pedestrian while turning right at a red light or stop sign in 17% of the accidents. Figure 1. Percentage of Pedestrian Accidents Involving Children Aged 5-11 by Violation Type, San Diego Data Source: Statewide Integrated Traffic Reporting System (SWITRS), accessed 12/2013. Other findings according to SWITRS data on pedestrian accidents revealed the following: (a) 65% of the victims were male, (b) 35% of all accidents occurred between 3:00pm-6:00pm,

26 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 26 (c) nearly 65% of the accidents occurred mid-block rather than at intersections where street crossings would be expected, (d) just over 95% of the incidents occurred on dry road surfaces, (e) 82% occurred during daylight, and (f) nearly 66% of the incidents did not have pedestrian right-of-way traffic safety measures in place. Figure 2 shows the age breakdown of children involved in pedestrian accidents by age. In this figure it is clear that 6 year olds had the fewest number of incidents and 11 year olds experienced the highest. Figure 2. Percentage of Pedestrian Accident Victims by Age, San Diego, Data Source: Statewide Integrated Traffic Reporting System (SWITRS), accessed 12/2013. Figure 3 shows that minority populations in the age range of 5-11 years are overrepresented in the number of pedestrian accidents when considering their percentage of citywide population. For the study period, African Americans and Hispanics were involved in 26.6% and 42.8% of the incidents respectively, while only making up 6.7% and 28.8% of the general population within the City of San Diego (U. S. Census Bureau, 2011).

27 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 27 Figure 3. Comparison of Racial/Ethnic Characteristics of Pedestrian Accident Victims, Aged 5-11 and the Total City Composition by Percentage, San Diego, Source: Total city population: 2010 U.S. Census, prepared by U.S. Census Bureau Accident victims: County of San Diego, Health and Human Services Agency, Emergency Medical Services, San Diego County Trauma Registry and Medical Examiners Data, The Southeastern San Diego SRA is comprised of a diverse population, with minorities accounting for 87.4% of its total, compared to 51.4% for the city as a whole. Further, Hispanics make up 50.9% of the Southeastern SRA population as compared to 28.8% citywide, and African Americans 15.9% as compared to only 6.7% of the city s total population. The Southeastern SRA median household income is 78% of the city s median income, with 20.04% of the population living below the poverty level as compared to 14.6%. More significant is the comparison of levels of education attainment. While 71% of the Southeastern SRA population has completed high school compared to 87% for the entire city, only 12% of the Southeastern SRA population 25 years or older have a Bachelor degree as compared to 41% citywide.

28 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 28 Southeastern SRA housing characteristics reflect those of the city with 38% of housing units being multi-family or multiple units. The comparison groups of fifth grade students were from Chollas Mead Elementary in the Southeastern San Diego SRA and Hage Elementary in the Del Mar/Mira Mesa SRA. These two schools are comparable across a number of dimensions including similar student enrollments and both are located in close proximity to the highest levels of pediatric pedestrian accidents recorded in their respective SRA. Baseline testing and survey was conducted using a 14 question assessment on pedestrian safety and walking practices administered to students at both schools. The survey also assessed their method of transportation to and from school, the presence of adult supervision when walking, and parental involvement in regards to demonstrating pedestrian safety. Figure 4 shows the percentage of students from each school that responded they primarily walk to school; if they walk do they have adult supervision, the percentage of students that responded having discussed pedestrian safety with their parents, and whether their parents have demonstrated safe walking behaviors. Only 28% of Hage students reported that they usually walk to school with 78% of those who walk report having adult supervision, as compared to 59% of Chollas Mead students reporting they walk to school but only 49% are accompanied by adult supervision. Both student populations reported a high percentage of their parents have discussed pedestrian safety with them and demonstrated safe walking practices. Interestingly, while Chollas Mead students reported a far less percentage of adult supervision while walking to school, those who do walk to school indicated a higher percentage of parental involvement in both categories related to teaching and demonstrating safe walking practices.

29 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 29 Figure 4. Percentage Fifth Grade Students at Hage Elementary School (N=98) and Chollas Mead Elementary School (N=115) who Walk to School and Who Have Received Parental Pedestrian Safety Instruction, San Diego, Source: Student assessment designed and administered by author. Quiz question number provided in parentheses, See Appendix E. Figure 5 shows the results of each pedestrian related test question answered correctly by school, and the overall average score for the respective school. In this figure, a significant difference was observed when comparing the overall average quiz score between the two schools, where Hage students, as a group, answered 82.8% of the questions correctly, compared to an overall average of 69% for Chollas Mead. The most notable difference in correctly answered questions was seen with questions #10 and #12 where over a 20% disparity was observed in correct responses between the two schools. Both student populations answered question #10 incorrectly most frequently, which referred to the safest location and manner in

30 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 30 which to cross a street, where 62% of Hage students answered this question correctly as compared to only 37% of Chollas Mead students. Figure 5. Percentage of Correct Responses to Pedestrian Safety Quiz for Fifth Grade Students at Hage Elementary School (N=98) and Chollas Mead Elementary School (N=115), San Diego, Source: Student assessment designed and administered by author. Quiz question number provided in parentheses, See Appendix E. Another component of this research project was to observe the walking practices of students from both elementary schools as they were walking to and from school. Surveyors recorded the number of pedestrian safety violations observed based on predetermined unsafe behaviors (Appendix F). Figure 6 shows the numbers for each type of violation observed for the respective school. During two separate 20 minute observation periods at intersections and streets

31 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 31 adjacent to the schools, a total of 140 violations were observed between the two schools. Students from Hage Elementary were responsible for 51 violations (36.4%) and Chollas Mead students were observed committing 89 violations (63.5%). Hage students were observed to have fewer violations in all categories with the exception of Entering the street on traffic side where they had the same number of violations and Crossing between parked cars where Hage students had two more violations than Chollas students. The most significant difference was seen in kids Not walking on the sidewalk where Chollas Mead students had 13 violations (14.6%) as compared to three violations 5.9%) for Hage students. Crossing the street mid-block was the most frequent violation observed at both schools and accounted for 42% of all violations noted. Table 2. Percent of Observed Pedestrian Violations by School, San Diego, Hage (N=51) Chollas Mead (N=89) Not Walking on the Sidewalk 5.9% 14.6% Crossing the Street Mid-block 47.1% 39.3% Crossing Against Traffic Signal 3.9% 5.6% Running Across Street 9.8% 15.7% Crossing Between Parked Cars 19.6% 9.0% Entering Car on Traffic Side 2.0% 1.1% Crossing From Obstructed View 7.8% 7.9% Not Looking at Oncoming Traffic before Crossing 3.9% 6.7% % of Total Observed Violations (N=140) 36.4% 63.6% Source: observational data collected 1/14. Figure 6 illustrates the comparison of the schools and the relative difference in observed violations between the student populations. The numbers in this figure differ from those in Figure 5, in that it focuses on the differences in the number of observed violations between schools, rather than the percentage of violations across categories. Again, Chollas Mead had a

32 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 32 significant difference in most categories with the exception of two violation categories, and this school was found to have over 3 times the number of observed students Not walking on the sidewalk and nearly twice as many students Not looking at oncoming traffic when crossing the street compared to those observed for Hage students. Figure 6. Comparison of Relative Difference in Observed Pedestrian Traffic Violations, by School, San Diego, Source: observational data collected 1/14. Interview results with safety and school administrators revealed professional concerns and opinions of the pedestrian risk this study groups faces. Currently there are no formal pedestrian safety programs provided through the public schools in San Diego according to Mary Beth Moran, Program Coordinator with San Diego County Safe Kids (M. Moran, personal communication, November 15, 2013). Other than the Safe Routes to School funding, no other public funds are allocated to minimize the risk of pedestrian accidents. Federal grant funds are

33 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 33 allocated to the state of California; however, these funds are distributed after a review of individual county applications requesting education and engineering improvements. The Safe Kids coalition serves as the administrator for SRTS projects and funding coordination with the various agencies and school districts. Risk assessments are performed for each neighborhood using data from San Diego County and SWITRS. Only schools and neighborhoods identified as high risk receive federal and state grant funds, and the majority of the funding is earmarked for traffic and street improvement projects that are not funded through state taxes. Because of the perceived limited return on investment, very little funding is allocated for student education related to pedestrian safety. Based on Walk Audits performed by SRTS administrators at identified high risk schools, traffic safety improvement projects for adjacent streets are given top priority in funding decisions as the requests are processed through the respective school district and local governments. Personal observation of a SRTS Walk Audit completed on December 5, 2013 involved representatives from SRTS, Safe Kids Coalition, San Diego City School District, City Attorney s Office, and San Diego Police Department. Safety issues identified included nonfunctioning pedestrian traffic signals, unidentified student drop off areas, faded or missing pedestrian street signs, lack of controlled intersections within immediate area of school, and signs easily misunderstood or confusing to drivers. Interviews with principals from both schools confirmed the lack of any district sponsored pedestrian safety programs and they had no reasonable expectation that it will be added to the curriculum in the foreseeable future. This is not to suggest that school administrations fail to recognize the risks experienced by their particular student bodies, only that funding of such programs is limited. Indeed, during the interviews both principals discussed efforts to implement individual safety measures and required staff involvement in traffic supervision

34 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 34 before and after school. For example the principal of Hage Elementary, Eric Takeshita, initiated a new student drop off and pick up route and designated parent parking areas around his school after receiving district and city traffic engineering approval. In Mr. Takeshita s opinion, the biggest challenge to improving pedestrian safety for the students has been parental involvement and having them understand how it relates to the school as a whole and not just their individual child (E. Takeshita, personal communication, December 12, 2013). Julia Bridi is the principal of Chollas Mead Elementary, which was one of the schools selected to receive a SRTS Walk Audit in This audit identified several safety issues in the immediate vicinity of the school, including lack of signage, inadequate drop off routes and enforcement, and insufficient adult supervision in traffic areas. As a result of these findings, Ms. Bridi and her staff share in the responsibility of monitoring children walking to and from school directly at nearby intersections. Ms. Bridi stated that parental commitment to safety and reinforcing safe walking behaviors away from home is the most significant challenge to improving safety (J. Bridi, personal communication, January 17, 2014). Both principals listed parental supervision and behavioral role modeling as the most effective interventions related to pedestrian safety for children and reducing the risk of accidents. Results from surveys of comparable departments revealed various levels of involvement in pedestrian safety programs. There were a total of 68 responses to the 145 electronic surveys distributed. Of the responding departments, 36 (53%) participate in some type of official child safety program in their community (not limited to pedestrian safety). Only 34 (50%) department respondents consider child pedestrian accidents a significant risk in their community, with 23 (34%) departments having safety programs offered in their jurisdictions specific to child pedestrian safety. Among the 23 jurisdictions having a pedestrian safety program for children,

35 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 35 only seven (30%) of the fire departments serving those communities have department personnel that participate in the delivery of program information. Figure 7 identifies the institution/agency having administrative responsibility for the pedestrian safety programs in the jurisdictions reported as having such, with a fairly even distribution between schools, safety coalitions or community organizations, and public safety and health agencies. Figure 7. Distribution of Administration Institutions/Agencies Responsible for Pedestrian Safety Programs, San Diego, Source: Comparable Department Surveys Of the 68 departments responding to the survey, 45 (66%) felt that certain neighborhoods experienced a disproportionate number of the pedestrian accidents involving children, and when asked how they would characterize those affected neighborhoods, 47 (69%) indicated that their perception was that these areas are likely to be socioeconomically disadvantaged. An unexpected

36 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 36 finding based on survey responses was that only 11 (16%) of the departments reported having a Community Risk Reduction Officer and only one department was aware of any study related to the disparity of pedestrian accidents involving children in certain neighborhoods. Discussion The data on pedestrian injury and death involving children in the City of San Diego resonates with national patterns that show some segments of the population are at higher risk of being injured or killed from being hit by a vehicle. More specifically, minorities experience the highest risk of being involved in a pedestrian accident. The findings reported in the present study are consistent with previous metropolitan-level analyses that reveal many of the same demographic and community social-structural characteristics contribute to the higher number of incidents (Hilton, 2006). Although African Americans were involved in a lower number of accidents overall than Hispanics in San Diego during the period under study, they had a much higher accident rate, indicating that members of this group experience an elevated risk level in San Diego. This increased hazard also squares with findings at the national level, which again show that the African American population faces the highest risk for this type of victimization (Winn & Anderson, 2003). Because we know that individual characteristics (such as race/ethnicity) are not intrinsically associated with this higher risk, it is important to look elsewhere for explanatory factors. This study employed a systematic and comprehensive approach to examine the combination of cultural, environmental, beliefs, and parental involvement that are associated with this increased risk. But identifying what specific characteristics are most responsible for this risk cannot be determined just based on one data source, as there are too many overlapping factors that contribute to why certain areas experience higher accident rates. Because more of our minority population live in older socioeconomically

37 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 37 distressed communities, ones with fewer resources, that are more densely populated, and often characterized by a number of challenging structural realities (e.g., narrow streets, more street parking, fewer traffic engineering safety measures), it is not possible to reduce the higher number of accidents to just one or two of these factors. They are all important in understanding this type of motor vehicle accident. The neighborhoods in San Diego with higher numbers of pedestrian accidents tend to be located in or near commercial areas with heavy traffic flows and increased speeds, have more multi-family residential complexes and less open areas or community parks space for children to play. Since many of these contributing factors concentrate in the high risk neighborhoods, it is important to view such accidents as a multi-faceted phenomenon and abandon the tendency to attempt to isolate, or rank, which factor has more of an influence on increasing the chances of a child being involved in a pedestrian accident. Although it is logically intuitive that population density and traffic patterns would contribute to certain neighborhoods experiencing a higher number of accidents, one surprising finding from this study was that a disproportionate number of such accidents occurred in economically disadvantaged neighborhoods. With only three SRA s in the City of San Diego responsible for over 73% of all pedestrian accidents involving young children, it certainly focuses attention on the need for intervention in these areas while also leading to the question; why are children in these areas so susceptible to being hit by cars? Traffic engineering and design aimed at moving volumes of vehicles through congested areas can be detrimental to pedestrian safety with an increase in multilane roads that lack adequate sidewalks or crosswalks spaced far apart which encourages jaywalking. Yet, retrofitting existing roads or other safety measures can be cost prohibitive. Other engineering problems that increase the risk of pedestrian injury across all neighborhoods are the existence of work zones

38 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 38 encroaching on sidewalks limiting safe passage, poorly maintained sidewalks, and too short of WALK time or green phase to allow a child to cross an intersection safely. An interesting observation while surveying the children walking home from both schools was that many children practicing unsafe walking behaviors were accompanied by an adult who was either not correcting the unsafe behavior, or in some instances leading the way for the student observed to have unsafe practices. Children walking with an adult did not hesitate to follow the adult crossing mid-block or diagonal across a four way stop sign intersection. Some children ran across a street mid-block on the direction of a parent waving them across to a waiting car ride home. This observation confirms an American Academy of Pediatrics report which argues that many parents lack the basic knowledge of pedestrian safety and fail to teach children how to be safe in traffic (2009). The violation observed most at both schools was crossing mid-block either by kids alone or kids accompanied by an adult. Mid-block street crossing accounted for 42% of all the violations noted by observers which supports SWITRS data that the majority of child pedestrian accidents in San Diego (65%) and nationally (80%) occur at non-intersection locations (National Highway Traffic Safety Administration, 2010). Based on her years of experience in the child safety field and as the coordinator for San Diego County s safe Kids Coalition, Ms. Moran feels the institution having the most impact and effectiveness in teaching children safe walking habits is the family (2013). She feels confident that better and more informed parental supervision and involvement in teaching children safe pedestrian behaviors is critical to long term reduction in pedestrian related accidents. Both Hage and Chollas Meade Elementary schools studied for this paper are within the San Diego City School District and both lack any formal pedestrian safety curriculum. Competing budget and class time priorities prevent the introduction of such needed programs. When asked about the

39 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 39 discrepancy of accident numbers between the two neighborhoods surrounding their respective schools given the same school district and absence of safety education, both principals attributed the disparity to a level of supervision, role modeling, and lack of communication by parents regarding risks associated with walking in and around traffic. The principal at Chollas Mead, Julia Bridi, pointed out that despite her school participating in the SRTS Walk Audit in 2010, there still has not been any focus on educating the students or parents on pedestrian safety. Only improvements to traffic signage and lighting were made following the audit, which certainly improved the traffic environment for students, but lacked the necessary message to parents which would have a more lasting impact on children walking safely around traffic. As other studies have shown when evaluating the effectiveness of one time safety education to students without regular reinforcement and behavioral exercises that include parental involvement, the effectiveness seems to be limited in their efforts to reduce pedestrian accidents. Educators and administrators share the belief and opinions cited in the study on the WalkSafe program that only short term knowledge gains are experienced with single exposure to pedestrian education curriculums, as children will quickly revert back to their baseline knowledge and behaviors without follow up and reinforcement (Livingston et al., 2011). It was assumed that the students from a school having a lower academic performance would most likely not score as well on the written exam as compared to a higher performing school, and some ESL students would experience more challenges with understanding and answering the pedestrian safety questions. However, the difference between the two student populations was not expected to be as significant as the nearly 14% in overall average score seen. With neither school delivering any type of formal safety curriculum it would be expected that the baseline knowledge related to pedestrian safety would be only slightly different given the

40 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 40 academic difference in schools. But without further research and alternative evaluation methods, it is unknown whether the significant difference seen in exam scores is attributable to academics and the test taking abilities of students, or if it reflects a true underlying difference in their actual knowledge of pedestrian safety. The geographic area studied and the student populations evaluated fell within the boundaries of the same San Diego City School District which suggests that these students have been exposed to the same levels of formal pedestrian safety education. Without a formal safety program delivered through the schools in both areas, it stands to reason that the only explanation for the difference seen in student baseline knowledge and walking behaviors can be attributed to adult supervision and parental involvement in teaching safe practices. Although the traffic environment and neighborhood safety issues can explain some of the observed disparities in the number of accidents, the fact that students in the Southeastern San Diego SRA scored significantly lower on the safety quiz and were observed to practice unsafe walking behaviors more frequently indicates that culture, family beliefs and concerns for safety, as well as parental involvement play important roles in keeping children safe in and around traffic. Recommendations Based on the four years of incident data, observational surveys, and baseline testing it s evident that certain communities and populations experience a disproportionate number of pedestrian accidents among children 5-11 years of age. The disparity between many of the communities is significant as evidenced by the mapping of incident locations. More effort should be focused on improving traffic safety in these neighborhoods and increasing the pedestrian safety awareness of not only the children living in these high risk areas, but the parents of these

41 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 41 children as well. Based on the research and results presented in this paper, the following recommendations are proposed: 1. Public safety and health services agencies should be more involved in the assessment of high risk neighborhoods and populations, and develop strategies on implementing safety programs aimed reducing the risk of pedestrian accidents. 2. SRTS on site Walk Audits should include all public safety agencies responsible for responding to incidents and protecting the citizens of that particular community. 3. SRTS on site Walk Audits should encourage the participation of parents in these audits which will allow them the opportunity to provide input and opinions on safety concerns as well as directly observe the traffic engineering issues and inadequacies adjacent to the school and their neighborhood. 4. The Safe Kids coalition should allocate more of the federal and state grant funding to pedestrian safety skills training programs with regularly scheduled follow up and reinforcement sessions. This should include parental education aimed at increasing the awareness of pedestrian safety, the limitations children have with judging traffic situations, and the specific risks children face in their respective neighborhoods when walking in and around traffic. 5. Streets adjacent to schools and communities experiencing a higher frequency of pedestrian accidents involving children should receive more law enforcement presence during school travel times and strict enforcement of traffic laws should be observed.

42 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO Parent volunteer organizations should take a more active role by promoting safety education and awareness by creating an environment where everyone accepts the responsibility for increasing the safety for kids walking in the communities. 7. Public notices should be sent to parents in the area of any significant pedestrian accident involving a child to remind them of the dangers children face around traffic. 8. SDFD should budget and institute and full time Community Risk Reduction Officer that works with the various safety organizations and public safety agencies to produce current statistics and promote safety awareness by developing strategies to reduce the risk of identified hazards and affected populations.

43 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 43 References American Academy of Pediatrics. (2009). Committee report on injury, violence, and poison prevention (124: ). : Pediatrics. Annual report of fatal and injury pedestrian collisions [Annual report]. (2010). Retrieved from Statewide Integrated Traffic Records System: Centers for Disease Control and Prevention. (2005). Morbidity and mortality weekly report [Weekly report 54 (6)]. Atlanta, GA: Centers for Disease Control and Prevention. Centers for Disease Control and Prevention. (2008). Kids walk-to-school: then and now-barriers and solutions [Fact sheet]. Retrieved from : Centers for Disease Control and Prevention. (2011). Retrieved from Web-based Injury Statistics Query and Reporting System (WISQARS): Chakravarthy, B., Anderson, C. L., Ludlow, J., Lotfipour, S., & Vaca, F. E. (2010). The relationship of pedestrian injuries to socioeconomic characteristics in a large Southern California county. Retrieved from Pubmed.gov: Christoffel, K. K., & Schofer, D. M. (1996). Psychological factors in childhood pedestrian injury: a matched case-control study. Pediatrics, 97(97), City of San Diego. (2013). County of San Diego, Health and Human Services Agency. (2010). Transportation related injuries [Annual report]. San Diego, CA: County of San Diego Health and Human Services, Trauma Registry Data.

44 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 44 Executive analysis of community risk reduction (2 ed.). (2012). Emmitsburg, MD: FEMA- National Fire Academy. FY2013 Annual Report [Annual Report]. (2013). San Diego Fire-Rescue Department: San Diego Fire-Rescue Department. Hilton, J. (2006). Race and ethnicity factors in fatal motor vehicle traffic crashes [Fact Sheet]. : National Highway Traffic Safety Administration. Jacobsen, P., Anderson, C. L., Winn, D. G., Moffat, J., Agran, P. F., & Sarkar, S. (2000). Child pedestrian injuries on residential streets: implications for traffic engineering. Retrieved from Institute of Transportation Engineers website: Leading causes of unintentional injury death in San Diego County [Annual report]. (2009). California: California Department of Public Health, Vital Statistics. Livingston, D. H., Suber, I., Clancy, S. F., Passannante, M. R., & Lavery, R. F. (2011). Annual pediatric pedestrian education does not improve pedestrian behavior [White Paper]. Retrieved from National Institute for Health website: Mazurek, A. (1994). Pediatric injury patterns [Annual Report]. International Anesthesiology Clinics, 32(1). Nance, M. L., Hawkins, L. A., Vivarelli-O Neil, C. C., & Winston, F. K. (2004). Optimal driving conditions are the most common injury conditions for child pedestrians [Magazine]. Pediatric Emergency Care, 20(9). National Center for Safe Routes to School. (2013). History of SRTS [Fact Sheet]. Retrieved from National Center for Safe Routes to School website:

45 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 45 National Highway Traffic Safety Administration. (2010). Pedestrian fatalities by non-motorist location and age [Fact Sheet]. Washington, DC: National Highway Traffic Safety Administration. Pedestrian and Bicycle Information Center. ( ). Pedestrian crash types summary report [Summary report]. Retrieved from Pedestrian and Bicycle Information Center: Safe Kids Gainesville Hall. (2005). Pedestrian safety news [Fact sheet]. Retrieved from Safe Kids Gainesville Hall website: Schieber, R. A., & Vegega, M. E. (2002). Reducing childhood pedestrian injuries (Volume 8 - Supplement I). Kennebunkport, ME: BMJ Publishing Group. Sciortino, S., Vassar, M., Radetsky, M., & Knudson, M. M. (2005). San Francisco pedestrian injury surveillance: mapping, under-reporting, and injury severity in police and hospital records [Annual Report]. : Accident Analysis and Prevention. Traffic safety facts data: children [Fact sheet HS ]. (2007). Washington, DC: National Traffic Highway Safety Administration. U. S. Census Bureau. (2011). [Summary file]. Retrieved from U.S. Census Bureau: US Department of Transportation, Federal Highway Administration. (1969). Nationwide personal transportation study: transportation characteristics of schoolchildren (Report No. 4). Retrieved from United States Fire Administration. (2012). USFA strategic plan - fiscal years [Strategic Goals]. Emmitsburg, MD: U.S. Department of Homeland Security.

46 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 46 Winn, D., & Anderson, C. (2003). Understanding and preventing child pedestrian injuries and fatalities: the status of prevention efforts in California [White paper]. Retrieved from University of California, Center for Trauma and Injury Prevention Research website:

47 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 47 Appendix A Distribution of Pedestrian Accidents in San Diego,

48 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 48 Appendix B Demographics of Southeastern and Del Mar/Mira Mesa SRA

49 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 49

50 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 50

51 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 51

52 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 52 Appendix C Interview Questions for Safe Kids Program Coordinator Interview conducted with: Mary Beth Moran, Program Coordinator, Safe Kids Coalition 1. How long have you been Program Coordinator with Safe Kids? 2. Please explain the historical background of Safe Kids? 3. What level of involvement does Safe Kids have child pedestrian safety programs? 4. Does Safe Kids develop and present education on pedestrian safety? 5. What formal pedestrian safety programs exist and are available to children in the City of San Diego? 6. What is your relationship with the schools when it comes to pedestrian safety? 7. What criteria does Safe Kids use in determining high risk populations? 8. Are you aware of any programs directed educating for parents on child pedestrian safety? 9. Through your experience, what factors have you found contribute to the risk of a pedestrian accidents in children? 10. Are there any specific components of a pedestrian safety program you feel are essential for it to be effective and successful? 11. What role does Safe Kids play in the Safe Routes to School (SRTS) program? 12. What factors do you feel have the most influence on the risk to children being involved in a pedestrian accident? 13. Who or what institution do you think should have the responsibility of teaching and reinforcing pedestrian safety practices with children?

53 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 53 Appendix D Interview Questions for School Principals Interviews conducted with: Eric Takeshita, Principal, Hage Elementary Julia Bridi, Principal, Chollas Mead Elementary 1. How long have you been Principal at this school? 2. What is your total student population? 3. Do you feel pedestrian safety is an issue with your students? 4. Do you feel your student population is at a higher risk to pedestrian accidents than students at other elementary schools in the district? a. If yes, what do you attribute that higher risk to? 5. Are there environmental or traffic engineering challenges in your area that increase the pedestrian risk to your students? 6. Does the school district provide any pedestrian safety educational material? 7. Does your individual school present any pedestrian safety education? a. If yes, who presents it and what curriculum is used? 8. Do you recall any pedestrian safety programs in the past? a. If yes, were they effective and why were they discontinued? 9. Are you aware of any public agency sponsored programs related to pedestrian safety? 10. Are you aware of any pedestrian safety literature distributed to parents recently? 11. Does your school have a safety patrol assisting with traffic before and after school? 12. Are their parent volunteers involved with directing traffic and assisting pedestrian traffic before and after school? 13. If the school district was to offer a formal pedestrian safety curriculum, do you think it would be effective and well received? 14. Who or what institution do you think should have the responsibility of teaching and reinforcing pedestrian safety practices with children?

54 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 54 Appendix E Pedestrian Safety Quiz

55 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 55

56 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 56 Appendix F Observational Survey Tally Sheet

57 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 57 Appendix G Survey on Child Pedestrian Safety

58 CHILD PEDESTRIAN ACCIDENTS IN SAN DIEGO 58