STUDY OBJECTIVES: To identify the determinants of childhood pedestrian injuries, taking the child's exposure to the road environment into account. DESIGN: This was a case-control study. SETTING AND PARTICIPANTS: The study was conducted in Perth, Western Australia between 1991 and 1993. Altogether 100 injured and 400 uninjured child pedestrians aged 1 to 14 years were studied. Aspects of the child's social and physical environments, measures of his or her behaviour, cognitive skills, and "habitual" exposure to the road environment, as well as his or her knowledge of road safety, were recorded. MAIN RESULTS: The likelihood of injury increased by 12% with each 10,000 vehicles per day increase in the volume of traffic (odds ratio (OR) 1.12, 95% confidence interval (CI) = 1.05, 1.19) on roads most frequently crossed. In addition, the presence of visual obstacles on the verge of the child's street of residence increased the likelihood of injury by more than 2.6 times (OR 2.68, 95% CI = 1.42, 5.02). In contrast, the absence of footpaths was associated with a 52% reduction in the likelihood of injury compared with the presence of footpaths on the child's street of residence (OR 0.48, 95% CI = 0.27, 0.87). CONCLUSION: The amount of exposure to the road environment and the nature of the road environment to which the child pedestrian was exposed partly influenced the likelihood of injury in children from low socioeconomic areas, male children, and children aged 13 to 14 years. Until now, the excess incidence of childhood pedestrian injuries in these subgroups of the population had not been explained because the child's exposure per se had not been examined.
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