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Enhancing Pedestrian Safety: A Comprehensive Review

This systematic review examines strategies for improving pedestrian safety through education interventions. With over 1 million road deaths annually, vulnerable pedestrians face significant risks. The review analyzed 15 randomised controlled trials conducted between 1976 to 1997 in high-income countries, targeting children and adults through direct and indirect education methods. Results showed positive effects on behavior, attitude, and knowledge, highlighting the importance of pedestrian education. Challenges included study limitations, biases, and diverse outcome measures. Law enforcement, environmental factors, and driver-related issues were not extensively covered, suggesting areas for further research. The review emphasizes the need for improved study quality, diverse interventions, and better outcome measurement practices in enhancing pedestrian safety. Published in The Cochrane Library and BMJ, this review serves as a valuable resource for injury prevention efforts.

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Enhancing Pedestrian Safety: A Comprehensive Review

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  1. Safety education of pedestriana systematic review O. Duperrex, F. Bunn, I. Roberts Sources of support: Institut de médecine sociale et préventive, Geneva, Switzerland Cochrane Injuries Grant, UK Medical Research Council, UK

  2. Road Deaths World 1,391,000

  3. Global problem: vulnerable pedestrians • over 1 million road deaths per year • fatality rate per billion passenger km: • pedestrians: 78 • car passengers: 5 • pedestrian deaths per year: • 280,000 children • 210,000 elderly

  4. Law enforcement Environnement Education Driver deaths Pedestrian crashes Pedestrian injuries Pedestrian behaviour disabilities attitude knowledge

  5. This Cochrane systematic review • is the result of a comprehensive search • in 10 transportation, educational and medical electronic databases • in 7 languages • contacts with authors & experts in the field • included only randomised controlled trials aimed at modifying pedestrian behaviour

  6. Results • Total hits 13 899 • Elligible 674 (5%) • Excluded • cohort study 1 • controlled non randomised 35 • RCT 5 • Included 15

  7. Methodological quality - generally poor (number of included RCTs = 15) adequate allocation concealment: 3 RCTs blinding of outcome assessment: 8 RCTs small study population (<200): 10 RCTs large losses to follow up in many studies

  8. Included studies(number of included RCTs) • conducted between 1976 to 1997 • Australia, Japan, Germany, UK, USA, Canada => none in low & middle income countries • participants 14 children (3y to 13y) 1 adults (institutionalised) 0 elderly

  9. Interventions(number of included RCTs) 8 direct education 7 indirect education - parents or teachers variety of settings: home - classroom - traffic situation variety of media: verbal - printed material - film - multi-media kit table-top model - mock intersection concert

  10. Outcomes • main outcomes: none crashes - deaths - injuries - disabilities • surrogate outcomes 6 behaviour - 5 attitude - 6 knowledge • big diversity • in the tools used to measure outcomes • in the conditions under which they were used • in the delays for post-test measurements (<1 to 8 mo) => no meta-analysis

  11. Effect of pedestrian education on behaviour - selection (5-9y) • Stop & look at the line of vision RR 1.79 (1.18 to 2.72) • Stop at the line of vision when crossing between parked cars RR 1.73 (1.39 to 2.14) • ’Safe behaviour' RR 2.13 (1.01 to 4.47) • Post-test Transfer Score SMD 0.83 (0.31 to 1.35)

  12. Indirect education versus No education Behaviour (observed) of 5 to 7 yr olds - post-test at 1 to 3 months RR (95%CI random) Stop & look at line of vision no distraction distraction (competition) 0.1 0.2 1 5 10 Favours control Favours intervention

  13. The effect of the intervention was lower in the later follow up period • 18 of the 24 behavioural outcomes, • 2 of the 4 attitude outcomes and • the 2 knowledge outcome measures. (6 RCTs)

  14. Law enforcement • Left out: • elderly • LMIC Environnement Education Driver deaths Pedestrian crashes Pedestrian injuries Pedestrian behaviour disabilities attitude ?? Education of children knowledge

  15. limitations • combined strategies overlooked • publication & other selection biases minimised but not excluded • poor quality of included trials • no trial from LMIC • outcomes of interest not usually measured • variety of interventions and outcomes: difficult to summarise

  16. challenges • identification of relevant studies - indexes • access to databases • search too sensitive • obtaining papers • variety of interventions and outcomes: difficult to summarise • time management - keep motivation for a marathon

  17. Thanks • to Frances Bunn and Ian Roberts for their support and participation as co-reviewers, • to authors who kindly replied to my requests, • to Reinhard Wentz and Irene Kwan for help with database searching and obtaining papers, • to Angela Huertas, Maaike Kruseman, Valdo Pezzoli and Finn Johnsen for help with translation, • to Marjan Loep from the Dutch Cochrane Centre for help with the Dutch titles, • to Toshihiko Yanagawa for help with translation and contacting Japanese experts.

  18. Published as: • Duperrex O, Roberts I, Bunn F. Safety education of pedestrians for injury prevention (Cochrane Review). In: The Cochrane Library, Issue 2, 2002. Oxford: Update Software. • Duperrex O., Bunn F. and Roberts I. Safety education of pedestrians for injury prevention: a systematic review of randomised controlled trials. BMJ. 2002 May 11; 324(7346):1129.

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