PH150A_finalreview - rm“ PH150A Review for Final Exam...

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Unformatted text preview: rm“ PH150A Review for Final Exam Notes on Paper maveé The majority of the final exam is based on “A Matched ICase-ControllStudy Evaluating the Effectiveness of Speed Humps in Reducing Child Pedestrian Injuries” by Tester, et al. Table l: Ignore the odds ratios and p—values in the last two columns of Table 1. McNemar Matched Pairs Analysis: This is a special statistical method for analyzing matched data. You do not need to know about it for the exam. The odds ratios calculated using this method are interpreted in THE SAME way as standard odds ratios. Conditional Logistic Regression: This is a special regression model used for analyzing matched data. Interpret the results as if it were a standard logistic regression model. Correction: On the last page in the limitations section, the last sentence of the second paragraph says “we excluded children in this age group from our study because such injuries are not related to the flow of street traffic.” You should read that as, “we excluded these injuries because they are not related to the flow of street traffic.” Assume that children under 5 were not specifically excluded from the study, just the driveway accidents were excluded (which often happen to kids in that age group). 1.What is the purpose of matching? “it? 4‘33 3? «2‘meth and A band / Maire“ w Con/Wl these “5 flat 3 {but} ‘A r design netted-J" 4:0 ybwl~c\ Cat/x 9L9» Lwh 2.0n what chgacteristics were the cases and controls matched? 2:. ” Stems, Sax; 33W; sieve» Bt- hi‘fl‘ti’l, u that at em? “3 ext—3%“ (awn “Hy-s Levi; fit new? *3 Jméaw‘ $€laeafitnv fl ‘9 ' ‘ ’2;— wt g; My; w ‘ J.» ‘ t, \"i Dew“, belt?” §E(Q Ll {Eff—w armada" cat as saws—ca: a. pm 3.What is the study population? _ Q42 side/ta ls‘jew gist W 535:5“? (“ma-j 93 MM)?" WLDWCiS' E \ Qfiskbxdt K “N “M mews as usm H gQOCCLzP .. 83M? " ' 4.What are two possible sources of selection bias in this study? sClqlléxafl Ml Mu? Paighlasplqggig» \ ‘» NM “M ME MG“? cesaflwlfl ' ' moan,“ J “3337:? ‘ - MW he“ ‘ K : f5.|\ ’- W “9on9 Elixilalfl‘) Suzi» lnrt é (Sinai 32+ SH“: «as “#3 5.Which variable dmmmfimmm’m I 6* in !. 4&5. mgkfib a £39 “ 4"“ twwfim-le‘ ét‘W‘eCé‘Mv-c— mm: grim g k L as as fiéfw fl 2 ‘ ngecLl'vas ~>igmé spec£ lam/‘3 it] (M 35 Ihv Whatdidt aoo 0 utthe We “E i» W“ __ Amide (Anode, L7 “WIN? \3 KKMAUZ" fl 7 :MN ii'aé ($961 Quatvdz w/ W—Et‘e. Wt a flwPflwag (AM/L5 I CW WV!“ écclwt Shel) 7lWhat level of prevention does this study address? =1. m'lr ‘l p) m Mo. \W 8.Recall bias is a common problem associated with case—control studies. Is there a source of recall bias in the study? Why or why not? 3995‘?" 5&3 Mum; Cfifiafi W doiioemé 37%.: lfltflb’l beam lads W bif- g +162 kmLieflvQ W (EDD 4V? 9in 7 E" ‘o 6': aé w W :3“; i149 lib/:3 daft“ Wt» Moo (5;) iika 43¢“? rem 9.After performing univariate/unadjusted analyses, which variable(s) was/were considered potential confounder(s) and Why? I €>E$ “ gown?ch - Ch? 2 ~_,__________. 10.1r1 Table 2, what is the difference between the two ORs reported for “Neighborhood injury?” Nashua» 0.51“) m) OM31 {03 11.Why are there two adjusted odds ratios in Table 2? N168 W whore, vweJ’V‘Q/l (K) t) mm) M «enuxmcgou w; “stump 23 Spcrfll}_{_’ m imigp “LrQJLj (gained 12. a) Interpret the OR 0.47 in Table 2. [OR only] «Rep CdSJs\~D '95“ e‘c‘mxcu‘)’ Lost) My“ ‘ (Marla 54r— meal, (,4 Gr‘iwofig sf" >el\») kywé (94 a CM M 04o“ b) Interpret the corresponding 95% Confidence Interval [not including significance]. “SE/too in” L053: Ham w} b} l? ‘2 w W“ W (L536) CXJ‘ __ .“Q Lego? R mega J7 ‘L K ( é . PMSQ, it A 93 ("9 “39" e C) Is this OR statistically significant? Why or why not? t / Md: (.5/ 13.0verall, What teehnique(s) did the authors use to address potential confounding in the study? lwxcérdub Cl swag MAQl 14.In your opinion, do you think that the association that the authors found is causal? Circle YES or NO. Use 2 of Hill’s criteria to justify your answer. .. twat The following is the original point estimate of the relationship between presence of a speed bump within 1 block of a child’s home and child injury in the neighborhood. Original OR and 95% confidence interval: 0.50 (0.27, 0.89) Suppose the authors had data on sidewalks on the children’s streets. The following are point estimates of the relationship between presence of a speed bump within 1 block of a child’s home and child injury in the neighborhood, stratified by presence or absence of sidewalks on the child’s street. OR and 95% CI of speed bumps and child injury rgAny sidewalks on child’s street: (0.90, 1.04) 4N0 s1dewalks on chlld’s street: E0 (032, 0.46) 15.1s this an example of ' teraction/effect modification, ‘ nfounding or neither and why? 16. Recall your fact sheet topic. Suppose you were asked to design a study to examine a question that remains unanswered in your topic. Answer the following questions. A. What is the study question (include the exposure and outcome)? B. What study design would you use and why? In the discussion, the authors discuss “overmatching” on SES. In your own words, explain What this means. Muifii: uripiww/d iv» CREE Camlwi C \5 SJ 7 A Mt LL’LM OflLCLJVV‘i‘ A Matched Case-Control Study Evaluating the Effectiveness of Speed Humps in R... June M Tester; George W Rutherford; Zachaiy Wald; Mary W Rutherford American Journal of Public Health: Apr 2004; 94, 4; ABI/INFORM Global pg. 646 ll Matched Base—Control Study Evaluating the Effectiveness of Speed Humps in Reducing Child Pedestrian Injuries I June M. Tester, MD. MPHt George W. Rutherford, MD, Zachary Waid, MCF.‘ and Mary W. Rutherford. MD Pedestrian iniilri used by automobile eol- lisious are a leading,I enlist: ol'donlh illlltlllli ehildren aged 5 to l4 yeai's.‘ "the demo- giapliie elioraeleiislies ()l't‘lilltll'l'ii iniumd by automobiles have remained the same over the. past. 20 years, with boys. children be, tween the ages ol' 5 and S) years, and eliildren living in neighlioi'l‘iomls o!~ low soi'ioeeononiii: status (SECS) at highest risk.“I " ("lnldren t‘n mult- to sthool or at play in ."iiint ol'llieii' homes are exposed to roads and street tral‘lie. :\l()(lll:\-'lllg ti'atl'te. patterns is a passive and siiqtainalili: public: health inter- vention that may make children's living envi» i‘iiinnenls sal'eizl 'l'i'allit‘ patterns can he mode lied with a number ol' engineering strategies [lli‘ti lat] under the riilirii: ol“liallic: calming.” Disliinzl l'roin speed liniitsigns or stop signs. li'allit- t‘alining measures such its speed :nimps. street closures. median barriers. and battle circles are suee ssliil in providing; long— terin solely tor pedestrians and motorists he, ruitsc- they are pliysii-al sli‘iielums with llK' signs that tilt} setlionl'm’einpr Hillier than requiring police ('Elllll‘tl‘lllfllll,“ ‘l For years. liui'opeiin eouiiuies sueii as Deni inarls. the Netherlands. and Great Britain, as well as Australia and New Zealetud, have ini- zets ot" tral' plonieuled and tested the, twiliniiip.‘J A report published in British Co- lumbia siiiiiiiiai'ired 413» international studies that demonstrated Ilrdut'tions in eollisioi': lrc- (iuency rates ranging; lion! 8% to ItitJ‘l’o alter iinpleanentaiion ol‘ tral'lli‘. calming measures!y 1“. Danish study showed that. in comparison thl'l r'onlrol streets. 7294i l‘ewor injuries oe- uurmd on mperinienlai streets lintorporatinp a variety ()I' lrallii' eriiiiniig measures in addi- tion to new speed zoning ri'qtnrei‘i‘iiuilfi ‘0 [\s a result ol‘ the slice ssliil ol'l'orts In other eoiintries, there is developing interest in trail- l‘ie. calming in the Linited States. and tht 'edr ei'al Highway [\dniinistrtition, iii eoopmution with the, institute ol'l'ransporlatioti Engineers, has inittaled (I national trullii‘. (‘iilniing techni- 646 3 Research and Practice | Peer Rev-ewed | Tester et ai. Methods, We oouitL ‘ in in a lit Results. A iniiltivz 0t etiitd pedestrian injuries and cal assistance project." i lowevei', the majority ol'sal‘el.’ studies i'ocatsiiipr on Lrallic calming measures have assessed aceulent statistics be? lore and alter installation, and there is no available hospit:-il-liased information on the speriilie eller ot' these interventions on child- hood pedestrian injury. Oakland has historically been one ol‘ the most dangerous cities in Calilornia in which to he a pedestrian, exhibiting, the example, the highest rate ol' pedestrian latalilies among the. state‘ eitios in lilllfid” In that. year. alter a series oi'ehild pedestrian deaths. the Oak- land Pedestrian Safety Project was thrilled. 'l‘his unlllldiselplinary alliance addressed child and senior pedestrian iniuries oeeni’riiig in the city of Oakland and advocated for installation ol'speed bumps. Over the 5-year period 1995 to 2000. Oakland installed about listlti speed bumps on residential streets to this study, we examined the cited ol‘ residing on a. street wiLh speed bumps on the odds ol'uliild pedestrian injuries in Oakland. l‘i‘lETiltl DE; We coiidueted a matched easeweoiilrol study among Oakland residents younger than M l5 3': rs over the Syeilr period March I, “’7' . lllgt'),l(ii\ilill't'l1 |. 2.000. idst‘ patients were PM children who were seen In the emergency de- partment at Children's Hospital Oakland al'tei‘ Otiieciives. We evaluated the. protective eitoctiveness ot speed humps in reducing, child p()d(.‘5ll'l?il'l initlries in residential i‘iolghboi'l'ioods. “ed a matched Gas juries involving hi' —control study over a 51-year period among .itiie. emergency doparunent after being struck by an auioriiooile. ite conditional logistic rogresston analysis showed that snot-id humps were associated with lower nrlds of Children being injured within their neighbor hood lilt'llltfiltltl odds ratio (Jilin-i 0.47) and being struck in trout 01 their home [adjusted 1,40). Ethnicity (but not socioeconomic Status) was inrlopr-inciently associated wit-i was adjusted for in the i'ogrr-issmn iriodel. Conclusions, Our findings suggest that speed humps male) children‘s living, environ inenls sailor. (Am ll’tibtie f-leattli. 2001119 164677650] having been struelc and iniured by an auto- mobile on a residential street. Since this hos pital receives all lJL‘tll‘dll'tL‘ amhuliuieo trauma transports {including deaths on the seene) Item the pity ot Oakland, it was (tonsidored an appropriate [flint-('13 to target E‘lllltl pedestri- ans injured in Oaldand. Case patients were each [roinpartid Wllh 2 respeetive controls matched in regard to age and gender The purpose of the study was to determine whether these el‘iildi‘cn who had been SEl‘lJL'lt -' to live :i' less lilrcii by automobiles - an near a speed bump than their peers who live'rTTfi‘Tlii: same city boundaries but. visited (liiv tin a reason other than being hit by a ear We iilenlil‘ied ease patiean I'i:h'ospeetively lrom it ti'auniat database, using; International (Ifrissifi'mlion. offlixeuses ($th Revision)" it involving collision with a pedestrian). Cases ,ode [ilit4] [motor vehiele lrul'lir. aeeident were lilliitttd to those involvmgji children youn— ger than 15 years who were residents ol' the (:in oi Oakland and who were injured or died as a result of the collision. We reviewed charts and omeigeney medieal sL.i\'1i:e data sheets to eliminate parking; lot llijtll‘lt'h, in? ‘llSL‘l who had been mis- red .r. : eta. died as ped tons, and injlll‘i by eliildren in driveway rollover eolhsioiis. in addition, we reviewed tmltit; report data l‘I‘Oi‘n the Oakland Police Department primarily to American Journal at Public Health l April 2004. Vol 90, No. 4 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. (:onlirm lnc‘nlinns nicollisionb. Whoa) lthCFr Hell'y_ we rovinwucl original lrnllii: ri'porlh lbr lurlhvr (.:lnriE'i('alinn. Wit nlsu rcnllii‘Li-il our analysis to izhihlrt‘n iniunzrl or killmi wilhin (1.25 mi (0.4 km) nl‘ l!t)ll!(‘ and usud a shuvl zilluh‘” in (luhu‘lnini‘ wholhcr Lin: injury niiczurruil on Lhc‘ Sll‘l‘t‘l Mimic pl' Lin» (:hilil‘s residence (defined by l\"hli\|lnr r:L lllf‘ :15 UN! “inili'x s-lrwrli‘li within u li.25’llll rnzlius (nlmlal F) lllnlillh, (:(anlCll'l‘i‘d lhi: “inrlmmdinp amighburhoml'“). or all n morn disdain. locnlion within ()nkluncl. ’l‘hv Lypc‘, nl Sli'l‘lll on which :2 Child liwrl wns r,th Hiliitd Willi lhv sll'm'l nllns‘ nu Wl‘ll‘li't Only rhilr (iron rmicling on minnr rondq (l'i'h‘ltll‘llillll shuns) rw‘ri! crl' ilqu l‘nr lhi: Hlucly‘. lnzctnnsu spntccl humps an: mslnllrcl only on such mails. :izd hump. or wiLhin E lilouli nl‘n Npl'flll hump. was our Living on n slrurl with 218] principal prmhiiiul‘ Viil‘lllhln. \=V1‘LISE’.ll(l‘zllil lrom (he Dupeirlnicnl ol‘li‘nl‘lit‘ Engineering in Oakland in determine the (exact localicms and {lotus ol' lllhiilllllllllll ul spam! lmmpS (Du- pnrlmin‘il ol"l‘rnlli:: linginnciring. unpilhlishctil (lthn‘ IQLlS—Zlfllll) Sprzcd llllmpfi that were located on llic ulhcr .‘il(l(lN of primaryr ol‘ SOC" nnrlan‘y rnzids lnrlvrii‘s) or wrrr: inslnllud nl'lnr lhi: dan ()I'Lhc iniln‘y \\-‘1‘l‘L‘ nnl r'nnsiilvnzd. As inunlmnr‘sl, wv mnlr hurl (‘z‘u‘ll ('axv pn- E.ii:nL according (.0 npv, pvndm: and (l'dlf‘ nl (emergency ilcpnrlmiinl visil. will] 2 (tonlrcils 9cm] in lhv mmrgranizy llupanim-ni Lhul 5mm: day ltn‘ n reason ullwr lhnn hiring slrnd: by :1 an: \‘VC l(l(‘lll.lll(é(l all ()lipihlc ('nnlrnls nl‘ Lhr: some: sex and With [he smm- yi‘nr ol‘ hirlh as Lhi: Ullh‘l: pnliimi lmm Lhc‘ derin log and rem- (lmnhr bt‘l(‘(3l,(‘El 2 such individuals In sriunhmis in which l.ll(‘l‘(! \vi'rc- l(!WI‘r than '2. ('nnlroi pn- liunls horn in [he snmc: yunr as lhi: mar) pn- l.il!l1l. WC‘ nieulc’ n random Llf Inn in Starch lhi: 1 your above or below Lhc digit nl' th E‘flhi‘ pnlitznl nuil lllttll 2 yams ulmvc m hulnw and k:nnn, nnlil £1Hilli:ll)ll'('1)llil’()l \w-Hiilrlilil'iml, Ninvlyrlhrm' purr'vnl nl‘ nll ('nnlrnls \wzm wilhin 2 yuan; nl' 2155‘, (ll lhail‘ i‘uspcrizllvv cast: pdliclnln. ConLrols WL-ri: I'K'SLI’lE'lf’d in (.hilclanil rusi~ plums livinijI on l‘UhiiltllllleIl shoals. W‘ trol- lulled inlm'mnlion on (:lhnicily 11nd insuramm Slnluti (rtlnasilitril us pi'ivzllct, publii', ur sulllpuyl li'om mmlicail rcti'ortla. ln iidiiiiinn. we cnlnggc» rile lhi' K ol'pulivnl and rtnanl house holda. using L990 cunsus dam on Inc-diam homuhold iniznmi' within Lin: (:eisc' palian or April 20011 Vol 94 No, Ii American lnumnl ol ill-hm: Honllh ('imirol's nunsiis eri. as low (Frill—$15 736i medium (Pillfi 737—2330 l 15]. or high (mum lheln $30 3113).” liinnlly, wr i-xenninril [hp 'l'Cll‘U]'(l.‘i ul‘ :1 'i' [Hilit‘tllh and ('nnlruls Lu nnr‘crr- ruin the pritsunria ol‘izinlain pt‘urtxisling cling? noses, such as :zi'ruhrnl palsy. munlnl rulm‘dun Linn, pnrnplcgiu. 2|an ilrvvlopnwnlni clc’lay, [hat would haw ul‘l‘vch‘d lhirir walking nhilily and. lhus. lhclr powniial lo hi2 (NPDSHl us pucll'sll'izlns in mnmnnhilv irnl’lic Sleilislicznl illlillyfilth wm‘cr pirl‘lin‘mttcl wiih Slain snllwnrv (5min Corp, (Iollngl: Station. ‘l'c‘xJ. WI‘ llSLlCl h’lC‘NK‘IHEll' nlnlizln'ri pnirs mmly’ w Suits in mamining lho. 200 r: control pairs (IOU (illfit' pnlicrnls vucth Lhélllillf‘tl Lo 2 (ton- u-nls), \Vlmn n Factor is l.l'llly p]‘(ll(‘,(1l.lV(’ againsl :iisr-nsr, lhrm ni‘c: more i‘ei'euit'onlrnl pnim in WllIKIll Lhi: misc lni'lm (and Lhn (:nnlrol has) lhls prulcdivu Jhulor lhun llii: (IUIIVHEML Scpnrnlu lllllVlll'lillC nhnlysvs l'ocnspd on nih- nir‘ily. r‘c-nsus tract l'ionsuhold inconn: Elllll in, Human slums lo determim' Wllt‘il'llll' thv \rirru indupnndirnl prudic‘Lnrs nl' child pt'dus- lrinn injurit'n, Onc'i: ignil'ii'nnl ll’<.(J3) variv ilhli‘s \\’(!I‘U Liclljl‘lnllli‘th m: (lOllSll‘llUlUll a mlll~ livnrizilv iznndilinnnl lng‘ixlii: regression model that inrvlndcnl only llu'su variables We iLll!|]lllll!il 236 llllllVlIlUlllh who hail llt'l‘fl scan in [he cnuzrguncy dopeu'lmunl during the study period and l'IiKl been assigned an l‘i—(t(l(lll nl‘ INMVT. W0 L-liminnlorl 52 polvnlinl 1113:va lianH ht‘t'nlisv they ll) wort.- not Ozlidnnrl msir clams nl lhi' limi: ()l‘udmissioal, (2) wort: iniuroll (llllh‘illl‘ (Joklnnth (3) wrrc: HIOI‘P lhnn l/l your}; ul'apu, (fl) \vm‘u hi 315 who llllll lawn misi— (illlh‘filllilil zis pi-ilwlrinns. nr (5) had hen-n lll_|lll'(1(l by em ill'll.nlll()l)ll() bucking up within n (lriwwziy or parkiin lul. \-V(: Ulimillnlml am niiclilicmnl H4 pmhmlinl palicnb‘ l)(E("dl|S‘t‘ Illlfy cilhttr livctil on an artery qlruul or had ham injun‘tl rllllSlClC ol' [hi'ir nnlghhorhrmd. yil‘hlllig‘ a: linzil quiin sam— pl4: ml 100 t‘aiSi: pnlicnls‘ (inst? paliunls and (:nnlrnls were similar in Et‘l‘ll'll-Z nl' any; gl‘lltltll'. lllhlll‘llllml .slzdusv mu— dinn huusuhold initnmcx and proportion will! an Lnnlurlying pwmorhid nunrodnvulcrpmun— [all dis;va ('Iiihlu l). Calm: palinan wrzrit morn liliizly in hi! Asian or ol‘ Hispanic nih- nirsirv 'l‘hi' mlrls (il'Axinn children having hen-n involved in; n pmlttslrizm in un m‘lilllfllll Tester ul Ell. i Peer Revicwnrl WM! 5.8 Lll1lltfiéls hiin ag lhnsu l'or While (‘hildrrin (Pu-Dial and Lhr n: 1‘l1llill't‘li having hm'n lll\’Ul\’L'(l wvrc- “Lil ids of Latino llllll‘H 215 high (I’ (UH). «\tllnllllllg(llillzillJl-d‘fi nl‘ c'nnll‘iik nrc- lenlldhh‘ (Ill l'l‘fllll‘k'l irtnn lln' nulhnm llnndpislvd odds rulius (Ulihl lilti'iw‘ll l‘l‘tim n multtlnml pnirs nnnly s showvil n prolrc‘livv i‘l'l'mzl ol‘h‘pnt'il hump}; in mmpnrisnn w1lh (:hihlrun iivinp; mun: lhzln .‘1 hlni'l: [rpm 51 H[)('(E(llllll]11). lll()H(‘ livrnp‘ wilhin u him-l: nl'n spend hump warn signil‘iunnLIy li‘ss lilu-ly to he iniurml n5 pl'tlmhuins willlin lhizii neigh- borhood (l‘l‘l’n \“4 235%: Oil-’2 1:30: SSW-h Conlidcnttt’ inlurvnl ICU-40.2108?!) ('liihlr‘, 2)‘ Among“ llu: lilll (:nsr- pillllfllléh 4i) V\'(!|'[‘il('lli21lly llil on lhi‘, hinrk in hunt nl' [.hnlr honu: (inrlm sirri‘l), .-‘\s u Sllllst‘L than: t‘hiltlrvn Wl‘l‘l' mm] li‘fits liln'J}r In llle- :1 nczurhy spend hump lhnn lhvir controls (lE‘l’n w: 2494:; ()lltfllflll‘éz $35‘hv (i|"’ll.lfi. 0.90) i'liihln Z]. Wv purlilrmiirl nmlllvnriulr lngixiir n-gmx sinn analyses minp hnlh prudirlor vnriahlns‘ and inithulmi mm: and ulhnivilv in tho inndrl. Allur control ll>r rum and Mimi Spt't‘tl humps \vin'i' ilssot'iulird wilh sipnil‘ii'nnily lownr ntlils ul’i: llill'llll Inning injm'ctil in [hirir nuighhnrhood (mljnslvd (Niall/l7; lll'i‘lll (II-22 0.24; (3.95) and bitingr Sll'Ll('l< on lllL‘ hlnck lm' Intrdinlztly in lmnlol lhnir homv (ndiusluil Ul llx’l—l); USU/h (Ilzllilfi, i.()(il(’ll1hlc\ 2) in our nlmn vnliunul study. no lnimd lhnl (‘lllhll'l'll who livcni within in llllu'ix ol' :1 sprawl hum hail signil'irnnlly lowvr mhh; nl' Iii-Eng leui'li Elll(l ininrcrd liy on :iuinnmlnih- in Elirzir ni‘ighlmrhninl. Living Within a l1l(l(‘l( Ul‘n Spl‘fitil hump was itxsnitinlucl with n roughly Zrl‘uld millivlinli in lln! nrlcls nl injury within onv's ni‘ighhnrlmnil (lllllllllilml OH 2047]. This prolr'itliw Mind \sz8 WW moa‘i' prir nounixtd Hmong ii": nulmul ul’rhildl‘nn who were injurrzd on 1hr l)l(l(‘l( immiiiiinli‘ly‘ in l'rnnl oi limii' hnnsc' [indi'x slri'i‘l). Cliililrrn living! within :1 l)l(l(‘l( 01' n spvrd hump ('Kl‘llll- “ml {12 Blind ruduc‘linn in ll!L’ odds nl’hvinjg injurctl on ll1(!l!' slrm‘l lznl_jml.i:il ()ll-’-l).’l). 'l'hctfiv I'Lesulis highligh! lhi' ul'ii‘.('li\-'i‘.nn55 ol‘ spurti humps in rrdni-ing rhild [Ji‘tluhll'il‘ll‘l iniul ll‘h‘. ficlbf’ilufll and Proclsm ‘ 647 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. TABLE 1~Qemugrapliic Characteristics of Case Patients and Controls ' Fatier-ts Controls .‘ 0) (a ; 2003 Grills Ratio Mala. Ne. tit.) 63 {68) £36 (68) rigs). y. mom (1‘11!) 6 8 {3.5) 6.6 (3. fl) lith'ilcny. ‘31: . Wide 3 (33 16 {8) Reiermmn Blast :35} MB] ll? (58.5) 2.4 Aztiuriranfutner ll (11'; 2t HUI») 3.2 E Hispanic 22 on 31 {not 4.3 15 lift} to (7.5} 5.8 insurance statw Ptlt‘ttlt} insurance 37 [1?) 43 (21.53 Relererce l‘ehlalt inmanm l8 [H “547 (73.5: 1.3 Selt pay 1) (fit it} (5] l 3 Household income. .5 [atlases liactJ High (>3m'li‘il 12417.: 39 {19.5} lleiemslce Medium (11373130 ! IE) it“; (75} 136 (68) 1.8 lewtO £57.36) 13 (13) .25 “25) 1.7 i’ffinlllllllG diagonals“ Milt! mental to {Italian I it) Ho 5) Dewzfu )inertnl lieia' I 010) ll (1.5) Hinze . rhinirlntc: analysis at age. ethnic-li- .‘2iti")(ilhnleiilycllmi ’yr Gilltlctltiilde yaswriated "tall P are oolalned from caudal? with child pedestrian an n. ants and nonreis were screeawe tor tile p we or any n! the tailoring gireimrbid diagnoses: cerebral palsy, martini I'Elfl’llillltlil,Ellhlldlpflgid paraplegia and (leveiopmcutrlt delay. Exposure to ‘i'i'ai‘r‘ie: hivronsed {'K'jltbilil‘t‘ tr) lrdlllt: [cespct'inlly trnl’l'ix: at high volume and replied) is at known "m ! trinn injuries. risl: [Eu-tor tor (‘hild pedestrian injury. Stc‘vrmr son and :‘otit’nguos sliowod that ell: increase their risk."’ in volume ol' ltltl whicles per hour is mime-L ntch with no iintrmnontzll incronsv ol’nhotit Need for Passive Environment Modification 2.0 in tho odds iil'imlvslrizm injury.“ Avon ergo Sjlr‘rds ll’ElW‘lt‘Jl on streets are also nwm» tiled with risk ot injt y. and at least 2 studms have domoimtinthd that :1 higlttir proportion pa 133 .187 .115 .038 .018 .356 717 .IOfi .265 . at tuggisnr regressen analyses, except lnr age. which was obtained with a Zriilile-ZI nsmlr'iatutl with higlim odd.» nl'ollihl pedun- n addition to tho typo of street. tht: number at streots that children cross on their way to school acorns to allll‘lil lrnllic illitl risk ol'cthild pedestrian llljtll'ltix, we l j TABLE 2~0iids of Pedestrian Injury Within a Child‘s Neighborhood and odds of injury on a j Chiéd’s Index Street of Residence When Child’s Home is Within 1 Block of a Speed Hump: Multivariate Model Cilst? Patients, Control Snitjenls. (n Ella), No. (it) tn 2005. No. (to OR (95% Cl)“ Adjusted DR {525% Cl)" Noiglitmrimciil iiajtay til (14) its (23) 0.5!} {0.27. 0.8%) 0/1! (0,1217. 0 95) letter sirnni injury 6 (1’).) 2d [El/l) 0.38 (0.15. 0.96) 0,40 [0.15.1.06} N1 .OR »-r and: ratio. Cl r. incense interlal. " 3L cl hum “dam-mar matched pairs anuij * er! item ’zlilltévéll’itllt‘. mood mcl l 648 l Roger-net 23rd pl'dLllCG j Peer Reviewed t léstel'ersn‘. Reproduced with permission of the copyright owner. ol' whirlos oxcetrdmg tho posted n]lt:t!(i Eiinil. is Given the relationship between (ExpOStl'I‘t: to have essentially 2 pmvcntion strategies at our disposal: we rznn protoct. children from lhst: moving trull'ir: hy modiliontion ol'eithor their behavior or l'htnr trail’l‘ic onvironimmt. Tim-o have honn mtlltlplt: attempts to modil'y (:hil~ drunks behavior. including school training prir jgrums,l7 “trnl'l'ic cliths" designed to ocluontl: parents and Children aboutsal'e behavior on hli‘ttlflbfim simulation games.” and community- !evol iIilurvontions?” l‘or the most part. how ever, those (EthICt‘tlltnlill cl'l‘orts huvo hum till“ able to exert. monninglhl changes in tho long term huhnvlor ol‘ [:hildrun. largely owing to the (lr’veloj'nimmtal limitations ol’jlrt'sdioot aged children.“ As u result. a great deal oi at: [billion has shil'tml to environment mortified lion and the promise it. holds l'm' allowing Clnld podustritm injury rntcs. Focus on Neighborhood Injury The Llclihomte locus ot'onr study was on perk ‘ltm injuries occurring in a child‘s own noighborhond (defined hora! as Within a 0.25mi radius ol' tho Child's homo) its: op— jlosed to all injurim including those occur— ring at more distant sites. We [housed on such injuries hocmlso although children lonvo their noijghlmrhoods with adults (and utter] in automobiles), most of their unstmcrvisocl time is liker to in: near home. in addition, the l.rnllii' rulininj; methods \vo examined can he applied only to residential stroctit One dyeiii‘ study that nxnminod Fatal head in» juries revealed that llljtll'lGS l0 podontrinns Vi the most common cause at l'atul head injuries and that 55qu ot‘ these injured were playing in tho strnol at tho Limo ol‘ the injury Ol' the i135 accidents thnt loll into this CEBU“ gory, only 1 involved a child who had hem] tinder adult supervision til the limo ol' the an cident (the remaining children had been sn~ pervixed by siblings or other ohildl‘cn). 'l'ho same study showntd that 80% (ll Fatal pedestrian mjttr' had hike.” jilacrl’. within 1 v ml {to km) oi the child‘s homo. l Among the [84 r‘hildrnn we initially identified For this study, |25 (68%) thl't: eligible lot“ the study hocallst: their injury occurred within 0.25 mi ol’ homo (tho othor childmn were olimmntcrd because they lived on arterial stmcls). 'I'lnno torn, our delta soggwts that. roughly two thirds nl‘ injuries occur within lhti 0.25 ml surround ing 21 child‘s I'mmc, ’nsniw' mtervontions that American Journal of Public Health j April2004.Voi9£1.Ne. 4 Further reproduction prohibited without permission. reduce child pedestrian injuries are likely to he ol‘ greater henehl. in areas where Children are prone to spend time Without adults. lll our study. SIDS was not a significant or dependent predictor ol' child pedestrian inr Jury. Mueller and colleagues l'ound that living in a census tract with a median household in come level helow 552000!) was associated than living with 7.0-l'old higher odds ol' iniii \ in a census tract with a median income level above $300003: Other researtth points to- ward an association hetweon increasing r- of pedestrian iniury and lower 5 , as ap— proximated by census tract of residence.1 spa— tial modeling ol' census tract and other data with a geographic information system,22 and more indirect indicators of lower SliS such as living near a (toiwonieneo store. gas station. or last lood store.” It is possible that. in our population, “ovei'inatehEng“ was the reason Slit? was not Found to he an independent ri,‘ ' l'aetor. Casi: patients were not matched with controls on 81-5, but it lower Sl'lS is associated with both increased odds ol' injury2 and increased odds oE‘ an enwrgrni'y ilepartn'lent visit,“ choosng controls ll'Ol‘ll the emergency dt- parlnient may have resulted in uvrirmatching in terms nl‘SliS. Limitations Our study involves potential methodolog— ical limitations. l-‘or example. limiting mea- surement to speed humps on a ehild’s street ignores the potential printoutivo el’lei‘t ol'spced humps around the r'orncr ll‘Olli a child's house. 'l'hiis. by measuring speed humps latl oral to an index street (rather than in ll l-hlordr railiusl. we may have unile timatcd the iel~ event rate ol' exposure to this intervention. which would have al'ieeted our estimation of the intervention’s proteetive impact. 'l‘here are also limitations involved with our study sample VVhili- relying on I‘lllt‘l' gency department visits ensured that we in- rorporutecl higher severity injuries (including deaths). injuries that were not reported to the emergency medical services land for which children may have been taken by their l‘tnnily to their regular doctor) would have been missed 'l‘his would Iiieali that our sample iindorrepmsented lower acuity in; juries. It is also possible that our sample uni April 2004. Vol 94, No 4 l American ioarnal orPublic Health ili:rrepresenteil younger Clultlmn. in that children younger than 5 years are more likely to he hit in t! ‘ 'driveway (ol'ton by a hacking automobile); "5; we exeludrd rzhilr than in this age group l'rom our study hr:- cause such injuries are not related to the llow of street trall'ie, liinally, it is possible that significant eon- l'ounding Factors were not addressed in this study, Some re. :arch suggests that tho presence of sidewalks is not a signii' v contributor to odds of iniury.’ " and other research suggests that the presence 01‘ sidir walks is a strong risk latter. with an odds ratio of “,0.” We would have liked to eon— trol lbl‘ the presence ol‘ sidewalks, but there were no reliahle retrospective data on side— walk or ourh presence available to do so Also. since much ol' the earlier literature points to lower St is a risk [actor for child pedestrian injury, the reason lor our iil‘dhil‘ ity to reprodiiee this relationship may have been that the tumors we used to approxi mate Sli5~eensus tract household income and medical insuranee status-are inappro- priate proxies for 5138. COlllCl..l.l§élth§ We l'ound that speed humps were assoer ated with a 515% to (50% reduction in the odds ol‘ iuyiry or death among children struck by an automobile in their neighborhood. These findings invite additional rest-arch on the protective el'l'eets ol‘ tral'l'ic ealming inten voutions and oll‘er a li'anieworlc tor studying; l‘ioilostt‘ian injuries in relation to physical in— torveritiims implemented within a lthtlllYlttl geographic region. Further confirmation ol' the protective ell‘eets ol‘sper-d humps would he useful and eoiiltl he augmented by addiv tionzil inl‘ormation on stop signs or other hie tors that. wou!d all'ect slowng distnui'izs on ei- lln‘rslilinrl ilfiplliftll1llllll).0ln‘5ltltly provides direct observatiomil evidence that speed humps are associated with a reduction in the odds ol'childhood pedestrian iniuries and supports the installation ol‘speoil humps by traffic: engineering departments. at iliinut the Arthur. At the time of Mac: study flruir' 'fiwtur (iris cl llifftfir'iit' Wilden! or (fir. {,tniw'isiii; oftfut'i'tbrniu. firm Front-Extra (out on 'lH'H Fonda/rite (4! tin’ Inherent}; rift kill/nrniri. li'rr'r‘xrhi‘p. (irony ll" litithrri‘inil is trill: the Department of'tpirtmni- oi'n_r;_o rind Hmsioiisiii's rd [fir liniw-isiw Iii-('irltfrli'lliil. him {lioirimt Sr’fmnl ri/iilit'rdmni'. Ali-Inna) l told is it‘lt'll (lili- jurors! li’uifea. (Jirlcirnid. ('rdif "iftiljij ll. ti‘iittii-rlimt is with the Children‘s Hospital and lfr'st'urr‘li i'rirtivrut Urildtind. [imprints jiir reprints dronid be sent in from -ll Teslri: 1H). lH’H who is now or (Wilda-Jr‘s fin-.pitrd (Julilwld. T-l'r'.‘ Fidfit. ()rilii'unii'. (3 l S} i‘htJF} irritant fitnr'testrrllii ,‘ifl\l.ilt€l'l‘lfi'li min) 'li'ua' (Mir-tr was mmlh'd .l ion it 3. 200$ Contributors l .\l. ‘Ii'sti'r l'HIlE‘t'lVl'tl tlu' slinly . ])£’I‘:til‘lt\t‘|l all analyst-s. rilltl tril thi: nailing ol'tlu' ornrlr. [I \\ lhilhrrl'nrd as- si mi in data anal} rs. lllli‘l'gill'léliltlll iil' Ilnilinps. and rmisiuns oi. llit' tll'lll‘lt‘ Z. \‘rzild (‘Ullll‘lllllll'tl to (unrip- inn ol ideas as m-ll as t't‘vii'h's ixl‘ lln- :Jl'lit‘li'. ln:i|i/.. .\].\\'. ltutlirt‘l'oril contributed to llir study design and itltt‘t‘lil't‘lillillll o! the hurling-z llcliimwieitgitioits \‘d- are gran-hit tor the ilssistznn‘r til the urethral rot: oran I. .Mlllllt‘l ol' lllt‘ Children :1 Hospital and lit‘fil‘lltl‘ll ('i'iiti-r Ell ()aldiinil. with sin-rial iliunlis to live Magi-r and Midge \ edge the uonderl’ul assistant 2- ol l.it‘t|lt'lh‘tlll llm'iil Kw.- ii'ki. ol'llwtlnlduurl l’nln‘l- l)i‘|1itl‘[2il(‘lll ‘llallu' Division. I'm prov "i/en, Also. we would lilw Io Ell'l\lllil\l' { lriiioi' report inlln'mailun for this \Itl ' and the inroluahln- llt'll) ol' 1 Henry (:lltli. who pi t)\'llll‘tl dale on sprrd hinnp installations in (liililand. lliiiiiaii l’ai'tiizilinnt Pmtuciinn ‘I'iiis ‘illltlt‘“1kI'I‘t'lt‘\\‘t'ilillliiilllpi‘flw‘tlllt'lllt‘lliblllll' honiil wirn‘ hoard ol'Clnliln'irs llospiliil and lii‘si'arrh [It'litizr at Oakland lllllll'lllt‘tl muss-iii “its not required in: the l't‘\'lt‘\\' hoaul huriiusi‘ patient»; did not m-i-d to he i-untnrlril for this irirusiii-i-iue {lulu :Iuahsis. References l. (h'ussniun l). The history of input rnnnol and the ('l!|tl(‘lilli)l(:_\1_\'lll't’ltlliiélllil iuliili-sri-i‘l injures. (inure .‘frii'd. Rlltlthltl‘ZIl—BZ. Z .\lnv|li‘r ll. ltivain l‘l’. |.iI .‘\\'|‘l.\')~ \S I' Q for E‘lllilllltultl [tl‘tlt‘h riini ‘run- mental lni‘tms and the iiioiin whi ‘lr c-ollisiim orrui't'enre. .lni/ Hind-info]. lililllLlIS Sallifilit) .5. l‘Ei-ss l. \"rrrcault It. .\lht‘nt|llll i.. l'rnppirer. hllllr pinsit ‘i'hi: t']!ltlt‘lililill:g\' nl road accidents in ihild- liniiii .‘llh’ f I’irfitir‘ limit/i NH??? '{3HA-ili)”. it lliriim ti. lleinnpriiphii' analysis at l luldhood 1i... injuries .“t’ffitHH‘J'r'i. maijoms. :isi ;)4‘(u' 1'). ltn'znu li. l’vdialrir inluiy ronirel in I‘ll“): ulieri' [in \w- get 1mm urn-'2 t’viiiimhs |.‘)‘ltl.|tij!‘H="s'§ ESHH ti. lining ll. ‘lt'rifiir' (hinting. Stunt rgf'rfrr f’mt-iirr “lashinigtun. 1X" lnslituli: oilIiinspmtalinu liriir'Ini-i'rs. llllill. 7. i'immii‘ohnins :lre fir'z'uiiir'np Univ thririimrun Ia‘x' fi'nridv. \‘iu‘ iiisrjnr flit/cit} Heitxnm Storm Hipnrt .\i ling; tor. \‘ir insuranrc‘ instituti- l'iir iii-gluon! Halon". 2000‘ till-Will —h. ti. \ppl \‘i'lsily ul‘ 1| l), limblr Shirts. ill-rlirli‘y. (Ceilil': tlnir lorniai l’ri'sr. lllril S]. l'.ll.|,{[‘l l?, 'l humsi-n l,l\’ Suleiy i-ll‘i-cls of spin! re- Tcsteroiaii, i Peer Reviewed l Research and Practice i 649 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. ...
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