title: Evaluation of the effectiveness of a pavement stencil in promoting safe behavior among elementary school children boarding school buses.
abstract: OBJECTIVE
  The majority of school bus-related fatalities among children attending elementary school in the United States occur as children board or alight from buses. Injuries occur during boarding when children enter the street and are struck by buses or other vehicles. This study evaluated the effectiveness of a stencil in the shape of a school bus applied to the pavement at a bus stop in improving safe behaviors at bus stops. Specifically, we assessed the frequency of children running toward the bus as it approached or entered the street.
  
  
  METHODS
  Elementary school bus stops with similar roadways, traffic profiles, and numbers of children boarding participated in the study. Stops were randomly assigned to an intervention group, in which children were instructed to remain within a safe area during boarding that was demarcated by a pavement stencil, or an education-only group, in which the safe area was demarcated by some existing environmental feature. Both groups received education about safe boarding procedures. Observers rated behavior at each stop daily for 5 consecutive weeks. Data were analyzed as bivariate odds of any unsafe behavior in the education-only group.
  
  
  RESULTS
  One hundred forty-five observations from seven bus stops with stencils and 174 daily observations from six education-only stops were completed. Observations of children in the education-only group were twice as likely to show unsafe behavior while waiting (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.3-3.6) and during boarding (OR, 2.1; 95% CI, 1.2-3.9). ORs were significantly higher in the education-only group for boys, girls, and children in grades 4 through 6. When no adult was present, there was a greater likelihood of unsafe behavior among all children in the education-only group while waiting (OR, 16.1; 95% CI, 3.9-72.4) and during boarding (OR, 15.0; 95% CI, 3.2-81.4). The presence of an adult at the stop did not have an independent effect on behavior. Children at education-only stops located on roadways with high traffic volume were more likely to engage in unsafe behavior while waiting (OR, 8.0; 95% CI, 3.8-17.3) and during boarding (OR, 4.9; 95% CI, 2.2-11.0). No differences were observed during boarding between stencil and education-only groups when 10 or more children were at the stops.
  
  
  CONCLUSIONS
  The pavement stencil, when accompanied by education about safe boarding, may represent a cost-effective approach to reducing unsafe behavior at bus stops by children of elementary school age.
authors.affiliation: Connecticut Childhood Injury Prevention Center, Hartford Hospital, Connecticut 06102-5037, USA.
authors.forename: G S
authors.initials: GS
authors.lastname: Burke
authors.forename: G D
authors.initials: GD
authors.lastname: Lapidus
authors.forename: R W
authors.initials: RW
authors.lastname: Zavoski
authors.forename: L
authors.initials: L
authors.lastname: Wallace
authors.forename: L I
authors.initials: LI
authors.lastname: Banco
mesh_terms: D000063:Accidents, Traffic / Q000517:prevention & control*; D002648:Child; D002652:Child Behavior; D002675:Child, Preschool; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008297:Male; D018986:Motor Vehicles; D012449:Safety; D012574:Schools