Development Department Research Programme Research Findings No. 81Road Accidents and Children Living in Disadvantaged Areas
David White, Robert Raeside, Derek Barker, Napier University
Scotland has a relatively high child pedestrian casualty rate. In 1997 3,795 children (aged 0-15 years) were killed or injured in road accidents, and of these, 1,892 were pedestrians. Previous studies have demonstrated the higher incidence of child pedestrian accidents occurring in deprived or disadvantaged areas. The Scottish Executive commissioned a detailed review of the research literature to explore the reasons for this, in particular the relationship between child pedestrian accidents and social exclusion, and to make recommendations for further research in this area.
- In understanding the factors influencing road accident rates in children it is difficult to separate the effects of the household in which they live from the area where they live. The balance of research evidence described in the review suggests that higher rates in disadvantaged areas are due more to household than to area characteristics.
- The risk of death for child pedestrians is highly class related. Children in the lowest socio-economic group are over 4 times more likely to be killed as pedestrians than their counterparts in the highest socio-economic group.
- The decline in child death rates from injury in road accidents over time has been less for children in the manual social classes than for children in the non-manual social classes, and as a consequence, the socio-economic mortality differentials have increased.
- Injuries to child pedestrian casualties from socio-economically disadvantaged families tend to be of greater severity. In addition, these children have a higher risk of physical injury in the first place.
- The risk of pedestrian injury is over 50% higher for the children of single mothers, compared with those in two parent families.
- Significant differences in child pedestrian injury rates based on ethnicity have been identified, particularly for younger 'non-white' children.
- On journeys to and from school deprived children are exposed to greater risk than more affluent children as they are less likely to travel to school by car or to be accompanied by an adult.
- Restricted access to play space and proximity of housing to busy roads, compounded by a lack of supervision in younger children appear to exacerbate road accident rates in disadvantaged areas.
The Government is committed to promoting social inclusion and equality of opportunity in Scotland. Social exclusion can seriously undermine equality of opportunity for children who live in areas characterised by high unemployment levels, low incomes, poor housing, high crime environments, bad health and family breakdown. Many of these areas also experience relatively high road traffic accident rates, particularly child pedestrian casualties. To better understand the reasons for this and the relationship between accidents, area disadvantage and social exclusion the Scottish Executive commissioned a review of the research literature.
The Review looked at the background to higher pedestrian casualty rates, including information on accidents for Scotland relative to other European and developed countries. Evidence on the links between all accidents and road accidents and socio-economic factors was reviewed, and related issues such as healthcare, education, the family, cultural aspects, the physical environment and geographic location considered. Children's perceptions of traffic risk and road safety education and training and the risk factors of journeys associated with travel to and from schools were investigated. In the light of the Review's findings, suggestions were made for areas of further research.
In 1997 there were 3,795 child casualties of road accidents in Scotland, representing 17% of all casualties. Of these child casualties, 1,892 were pedestrians, making up 46% of all pedestrian casualties. In Scotland child casualty rates per head of population increase with age, with the rate of 5-15 year olds three times higher than 0-4 year olds. Child pedestrian casualty rates in 1997 for fatal and serious injuries and for all severities were more than double the corresponding rates for pedestrian casualties of all ages. Scotland suffers a higher child pedestrian casualty rate than does England and Wales - 28% higher for fatalities, 53% higher for fatal and serious and 20% higher for all severities. The pedestrian fatality rate for Scotland was 2.1 per 100,000 population which was worse than the EC average of 1.9 per 100,000 population.
Factors associated with Road Accidents in Disadvantaged Areas
A number of hypotheses exist on the factors likely to affect accident risk among children living in deprived households or in disadvantaged areas. The Research Review was careful to distinguish between disadvantaged or deprived households and disadvantaged areas. Not all deprived households are located within areas defined as disadvantaged. Similarly, disadvantaged areas are not composed entirely of deprived households. While research has indicated that injury rates for child pedestrians are higher for those living in disadvantaged areas, much of this increased risk can be explained by factors affecting the individual.
Socio-economic factors (individual)
Accident rates are highly class related and the differentials between classes is widening. Between 1979-83 the (all) injury death rate for children in Social Class V was 3.5 times that of children in Social Class I. For the 1989-92 period the injury death rate of children in Social Class V was 5 times that of children in Social Class I. The decline in children's death rates from injury over time has been less for children in the manual social classes than children in the non-manual classes. Injuries in socio-economically disadvantaged families tend to be of greater severity, in addition to those children having a higher risk of physical injury in the first place.
With respect to road accidents only, research conducted at the household or individual level has confirmed that the risk of death for child pedestrians is also class related. Mortality statistics indicate that children in the lowest socio-economic group are over 4 times more likely to be killed as pedestrians than their counterparts in the highest socio-economic group.
The inequalities between social classes are more extreme in relation to child pedestrian deaths than either all injury deaths or all causes of death. Road accident fatalities constituted 51% of all child deaths from injury and poisoning 1979-82, and 44% 1989-92. Between these periods death rates declined by 30% and 39% respectively for Social Classes I and II but only 18% and 1% respectively in Classes IV and V.
The incidence of child pedestrian injury, in certain instances, matches that of all types of injury to children with regard to social, behavioural and environmental factors.
Socio-economic factors (area)
Investigations into the importance of area-related factors found that the casualty rates amongst residents from areas classified as relatively deprived were significantly higher than those from relatively affluent areas. It has been argued that those who benefit least from the motor vehicle seem disproportionally likely, given their relative exposure to risk, to die in road traffic accidents. The incidence of traffic injury in deprived urban areas is greater than in more prosperous areas.
Family Factors and Accident Risk
Research indicates that for individuals living in deprived households family factors are linked both to child pedestrian casualty rates and overall injury rates for children. Lone parenthood in particular is a risk factor for children, where the risk of child pedestrian injury is over 50% higher than in 2-parent families. Poverty, poor housing conditions and social isolation are likely to characterise areas in which lone parents often find themselves. However, these findings are often based on studies of urban areas and may not hold true for rural areas where social and cultural influences can be different.
One of the main factors affecting exposure to risk is the mode of transport on offer to children. Lack of access to a car is associated with a doubling of the risk of injury as a pedestrian and lack of access to a car is most likely amongst poorer households. Households of single elderly people or single parents have particularly low rates of car use (18% and 31% respectively) and single elderly people and single parents are predominately women.
The link between social deprivation and the high accident rate of child pedestrians may be partly explained in terms of increased exposure to hazardous environments. These environments may be the areas immediately surrounding individual households or further afield. Hazards include busy roads with a lack of safe crossing sites, the location of schools outwith the community, availability and access to safe play-areas etc. Child-rearing practices of lower socio-economic group families often, by necessity, involve less supervision with less time spent in shared activities. It has also been suggested that children from lower socio-economic groups may be encouraged to take part in activities that involve greater physical risk where competitive drives find an outlet in unsupervised activities in unprotected environments.
Accident Risk and Cultural Factors
Traffic accident studies have found significant differences in accident risk rates based on ethnicity. Research found that ethnic origin came through as an important accident indicator especially for 'non-white' children aged less than 11 years old. Accident reports showed that, in some cases, the 'non-white' accident casualties had only recently arrived in the UK indicating possible problems in adapting to unfamiliar traffic environments. This may be due, in part, to area effects particularly if such individuals are resident in communities with a significant ethnic element. Other studies, however, have found moving to a new area to be insignificant with respect to children's traffic accidents.
Other research has indicated that Asian children are over-represented among pedestrian fatalities. Per head of population, those young pedestrians of Asian origin aged 0-9 years were over-represented in road accidents by a factor of 2. Much research in this area is inconclusive on whether ethnicity is predominantly a household or an area effect in influencing child pedestrian accident rates.
Risk Factors associated with the Physical Environment
A relationship was found in the research reviewed between the number of child pedestrian casualties and a number of physical and environmental factors. For example, the layout of the residential environment influences the safety of child pedestrians. In places where there have been engineering interventions, which have helped restrict vehicular access, speed and flow, there have been reductions in accident rates. Research into the social and environmental impact of a range of traffic-calmed schemes in Scotland found that in all cases the implementation of the traffic-calming measures has resulted in a reduction of speeds and accidents.
Findings from some studies indicate that the number of roads that children cross is a key determinant of the occurrence of child pedestrian injuries. Children from families with the lowest quarter of income cross 50% more roads than those in families in the highest income quarter. This may be due to the character of the urban areas in which they live , or to the lifestyle patterns and lack of alternative travel modes noted above.
Social Deprivation and Locational Factors
On the issue of comparing family and neighbourhood risk factors, it has been found that accidental injury rates for pre-school children were much higher in deprived urban neighbourhoods than in affluent areas. However, much of the variation in injury rates was accounted for by individual i.e. household factors. These include sex, young maternal age, number of elder siblings and distance from hospital, and, only to a lesser extent, whether or not they lived in a deprived neighbourhood. Important findings from such research also indicate that in the case of more severe injuries, single parenthood is significant at the individual level and the effect of area deprivation is stronger.
There is conflicting evidence as to whether people of low socio-economic status have poorer health due to the areas in which they live being health damaging, or whether ill health and mortality is wholly explained by personal behavioural and socio-economic factors.
Socio-Economic Factors and Healthcare
There is evidence that, in addition to increased injury rates including pedestrian casualty rates, children living in deprived areas or suffering from material disadvantage are liable to be over-represented in other health issues. Children and young people living in materially deprived conditions are more likely to be admitted to hospital than children living in more affluent conditions.
Research has concluded that road accidents form the tip of the morbidity 'iceberg' which includes a far wider range of transport impacts on the health of the population than is generally acknowledged. Large sections of the population may curtail use of certain modes of travel due to their perceived accident risk. Life-enhancing forms of travel such as cycling and walking may be dismissed as viable options, particularly by women and children. Moreover, it is argued that traffic also severs communities and diminishes social support networks, therefore imposing substantial health costs. This may be particularly pertinent for health-vulnerable groups such as young children of school age and the elderly.
Children's Behavioural Factors
Child pedestrian injuries occur significantly more often in poorer neighbourhoods with restricted access to play space and proximity of housing to busy streets. These injuries are related to psychological problems in children such as cognitive deficit, over-activity, conduct disorder and delinquency.
On the basis of a survey of almost 12,000 children it was found that aggressive behaviour was associated with all accidental injuries after allowing for psychological variables including social class; crowding; mother's psychological distress, age, and marital status; and child's sex. The magnitude of the child behavioural associations with accidents was consistent with and, in many cases, greater than the magnitude of the associations with non-behavioural characteristics. For example, the unadjusted relative risk of accidents resulting in hospitalisation in Social Class IV (semi-skilled) or V (unskilled manual labour) versus Social Class I, II or III (non-manual labour) was 1.5.
Aggressive behaviour and overactivity have been found to be associated with all accidental injuries for children. However, with respect to child pedestrian accidents in particular, it has been suggested that environmental influences are more significant than behavioural factors.
Deprivation Factors and Education
Many problems which manifest themselves in the education system, such as low attainment, under-achievement and disruption, are connected to patterns of disadvantage and inequality in society as a whole. It is argued that poverty, unemployment, lack of opportunity, poor health and healthcare, criminality and a whole range of other sources of stress on families and children are reflected in the difficulties which these children bring to, and present in, their schools.
There is evidence of a difference in the underlying socio-economic structure relating to education and training aimed specifically at reducing traffic accident risk. The problem of traffic safety among children and the effectiveness of voluntary traffic clubs has been investigated in studies both within the United Kingdom and elsewhere in the world. It has been concluded that although children's knowledge of appropriate safe behaviour increased after exposure to educational material, their actual behaviour was not affected. However, other research has found that training under normal traffic conditions supplemented with audio-visual presentations in school achieved major improvements in the road crossing behaviour of children.
The Journey to School
Several studies have examined the importance of the journey to and from school for children with respect to casualty rates. A considerable amount of information has been gathered from individual schoolchildren through surveys and observational studies. It is possible to identify various risk factors associated with the study sample. Problems, however, do exist as risk factors and exposure rates vary with location.
Research has examined how risks to schoolchildren vary with sex, age and affluence. Deprived children were found to be exposed to greater risk than affluent children and were less likely to travel to school by car or to be accompanied by an adult. While affluent pupils had longer journey times, in many other respects the deprived pupils were more exposed to risk. Fewer of the deprived pupils had travelled by car in the previous 2 days compared with affluent pupils. In addition deprived pupils were less likely to use a seat belt in the back of vehicles than the more affluent children.
On journeys to school, children's exposure to injury risk varies with different social, economic and environmental conditions. Younger children have lower exposure levels to traffic than older children and a higher proportion of traffic accidents occur to older children on journeys to or from school.
On the basis of available evidence it appears that children from disadvantaged areas are exposed to greater levels of accident risk through a combination of factors. Lack of parental supervision and access to a car result in journeys to and from school being more hazardous for deprived children than those from affluent areas. Safe access to supervised and/or safe play areas is also generally denied to those children living in disadvantaged areas.
In addition to increased exposure to the traffic environment for children from disadvantaged areas, there is also evidence that such children exhibit different behaviour patterns that may also contribute to higher accident rates. Such risk-taking behaviours in combination with higher exposure rates inevitably result in children from deprived areas being over-represented in traffic casualty statistics.
Based on the findings of the Literature Review, the following research areas have been identified as either enhancing existing research or are pertinent to road accidents and children living in disadvantaged areas in Scotland.
1. To understand the implications of social exclusion there is a need to further investigate different levels of exposure experienced by different road user groups. Until more work is undertaken on exposure to accidents, many of the conclusions from other studies will remain speculative.
2. Throughout the review of the literature a major gap in informative research emerged relating to a comparison of urban and rural risk factors for road traffic accidents. This is particularly key to any further work on social in/exclusion. In particular, a study of different exposure rates and travel patterns is required. Also studies of the behavioural and travel patterns of children in urban compared to rural communities should be carried out.
3. There is a need for more in depth work on an individual's comparative road traffic accident risk. Groups that could be investigated include children from lone parent families, children of certain ethnic backgrounds, children with perceptuo-motor deficiencies and also those children with restricted mobility. Principal in this comparative work should be the effect of social in/exclusion. Linked to this should be a study of the effect of different family and community support infrastructures.
4. Existing research methodologies require to be updated to take account of changes in the environment, the economy and social factors to identify changes in traffic accident rates over time. Of particular interest would be a statistical/economic investigation on 'closure trends' as targets are attempted.
5. There is a need for further research into possible mechanisms for changing the attitudes of different groups of road users. Issues relating to mobility, access and safety have become clear from the review of literature.
Note: A full reference list of sources used in the review of research literature is listed in the main Literature Review (see below).
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