Livingston David H, Suber Iesha, Snyder Dawn, Clancy Sharon F, Passannante Marian R, Lavery Robert F
Department of Surgery, Division of Trauma, UMDNJ-New Jersey Medical School, Newark, New Jersey, USA.
J Trauma. 2011 Nov;71(5):1120-4; discussion 1124-5. doi: 10.1097/TA.0b013e31822dd03c.
Pediatric pedestrian injuries are a major health care concern, specifically in urban centers. An educational program (WalkSafe), given one time during the school year, has been shown to improve childhood pedestrian safety. We examined whether this program could create similar long-term cognitive and behavioral changes in our school-aged children.
An established pediatric pedestrian curriculum was modified slightly for use in our area. Students K-fourth grade were exposed to the program once annually for 2 years. The program was carried out weekly for 3 consecutive weeks. The first and third sessions consisted of an educational module given by the classroom teacher. The second week consisted of an interactive assembly that allowed the children to demonstrate good pedestrian safety using a simulated street. Short- and intermediate-term cognitive knowledge was evaluated using standardized pre-, post- and 3-month follow-up tests. Long-term knowledge was assessed by comparing scores as students advanced in grade from year 1 to 2 of the program (K to first, first to second, etc.). At six schools during year 2, pedestrian behavior was measured through direct observation of children on city streets before and after administering the program. The project was approved by university and school board institutional review boards.
During the 2 years, 1,564 students from nine schools were educated. In both years of the program, students in all grades had a significant gain in test scores immediately after and at 3 months compared with baseline knowledge. In contrast, only students moving from grade 3 to 4 demonstrated long-term retention (K→1: 7.7 vs. 6.7; grade 1→2: 7.8 vs. 6.7; grade 2→3: 7.3 vs. 6.8; grade 3→4: 7.1 vs. 8.0; all p < 0.05 year 2 pretest vs. year 1 3-month posttest; analysis of variance and generalized linear model). Only 30% of children walk with an adult. Direct observation showed 64% of children stopped at the curb but only 8% looked left-right-left. Children walking alone were more likely to cross mid-block compared with those walking with an adult (12% vs. 3%; p < 0.001) and also tend to look left-right-left significantly more than those walking with an adult (67% vs. 20%; p < 0.0001).
A one-time annual educational program resulted in long-term knowledge retention between grades 3 and 4 only. In contrast, scores in younger grades reverted to baseline pretest values seen in year 1. Short- and intermediate-term knowledge gains were seen in all grades for both years. Because older children more often walk alone, we postulate that the improved retention may be the result of repeated exposure and practice as a pedestrian. Cognitive knowledge did not appear to translate into improved pedestrian behavior. Walking with an adult also had a negative impact on observed pedestrian safety behavior. The efficacy and impact of a one-time educational program may be insufficient to change long-term behavior and must be reevaluated.
儿童行人受伤是一个重大的医疗保健问题，在城市中心尤为如此。一项在学年期间进行一次的教育项目（WalkSafe）已被证明可提高儿童行人安全。我们研究了该项目是否能在我们的学龄儿童中产生类似的长期认知和行为变化。
对既定的儿童行人课程进行了轻微修改以适用于我们地区。幼儿园至四年级的学生每年接受一次该项目，为期2年。该项目连续3周每周进行一次。第一和第三次课程由课堂教师提供教育模块。第二周包括一次互动集会，让孩子们使用模拟街道展示良好的行人安全行为。使用标准化的课前、课后和3个月随访测试评估短期和中期认知知识。通过比较项目第1年到第2年学生年级升高时的分数（幼儿园到一年级、一年级到二年级等）来评估长期知识。在项目第2年的6所学校中，通过在实施项目前后直接观察城市街道上的儿童来测量行人行为。该项目获得了大学和学校董事会机构审查委员会的批准。
在这2年中，来自9所学校的1564名学生接受了教育。在项目的两年中，与基线知识相比，所有年级的学生在课后和3个月时的测试分数都有显著提高。相比之下，只有从三年级升到四年级的学生表现出长期记忆（幼儿园→一年级：7.7对6.7；一年级→二年级：7.8对6.7；二年级→三年级：7.3对6.8；三年级→四年级：7.1对8.0；项目第2年课前与第1年3个月后测相比，所有p<0.05；方差分析和广义线性模型）。只有30%的儿童与成人一起行走。直接观察显示，64%的儿童在路边停下，但只有8%的儿童左右左看。与和成人一起行走的儿童相比，独自行走的儿童更有可能在街区中间过马路（12%对3%；p<0.001），并且也比和成人一起行走的儿童更倾向于显著地左右左看（67%对20%；p<0.0001）。
每年一次的教育项目仅在三年级和四年级之间产生了长期知识记忆。相比之下，较低年级的分数恢复到了第1年的基线课前值。两年中所有年级都有短期和中期知识增长。由于年龄较大的儿童更常独自行走，我们推测记忆的改善可能是作为行人反复接触和练习的结果。认知知识似乎并未转化为改善的行人行为。与成人一起行走对观察到的行人安全行为也有负面影响。一次性教育项目的效果和影响可能不足以改变长期行为，必须重新评估。
