title: Randomized controlled trial to evaluate the effectiveness of a video game as a child pedestrian educational tool.
abstract: BACKGROUND
  Injury is the number one cause of death and disability in children in the United States and an increasingly important public health problem globally. While prevention of injuries is an important goal, prevention efforts are currently fragmented, poorly funded, and rarely studied. Among school-aged children, pedestrian crashes are a major mechanism of injury. We hypothesized that we could develop a game-based educational tool that would be effective in teaching elementary school children the principles of pedestrian safety.
  
  
  METHODS
  Between November 2011 and June 2013, second- and third-grade children in Los Angeles Unified School District were randomly assigned to play a unique interactive video game (Ace's Adventure) about pedestrian safety or to a traditional didactic session about pedestrian safety. A pretest and posttest were administered to the study participants. Afterward, study participants were observed for appropriate pedestrian behavior on a simulated street set called Street Smarts. All statistical analyses were performed using SAS version 9.2.
  
  
  RESULTS
  A total of 348 study participants took the pretest and posttest. There were 180 who were randomized to the didactic and 168 who were randomized to the video game. The didactic group demonstrated a higher mean score increase (1.01, p < 0.0001) as compared with the video game group (0.44, p < 0.0001). However, observation of study participants revealed that participants who played the video game, as compared with the didactic group, more frequently exhibited appropriate behavior during the following: exiting a parked car (p = 0.01), signaling to a car that was backing up (p = 0.01), signaling to a stopped car (p = 0.0002), and crossing the street (p = 0.01).
  
  
  CONCLUSIONS
  Students who played the educational video game about pedestrian safety performed similarly to those who attended a more traditional and labor-intensive didactic learning. Innovative educational methods, such as game playing, could significantly change our approach to injury prevention and have the potential to decrease the burden of injury among children worldwide.
authors.affiliation: From the Division of Pediatric Surgery (H.A., R.V.B., V.M., P.R., J.S.U.), Children's Hospital Los Angeles; Department of Surgery (M.M.K.), San Francisco General Hospital and Trauma Center; University of California, San Francisco Medicine (M.M.K.), University of Southern California; and Keck School of Medicine (R.V.B, J.S.U.), University of Southern California, Los Angeles, California.
authors.forename: Helen
authors.initials: H
authors.lastname: Arbogast
authors.forename: Rita V
authors.initials: RV
authors.lastname: Burke
authors.forename: Valerie
authors.initials: V
authors.lastname: Muller
authors.forename: Pearl
authors.initials: P
authors.lastname: Ruiz
authors.forename: M Margaret
authors.initials: MM
authors.lastname: Knudson
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Knudson
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Upperman
mesh_terms: D000063:Accidents, Traffic / Q000517:prevention & control*; D002648:Child; D005069:Evaluation Studies as Topic; D005260:Female; D006266:Health Education / Q000458:organization & administration*; D006801:Humans; D015141:Los Angeles; D016730:Program Development; D015397:Program Evaluation; D012449:Safety; D018910:Video Games; D016138:Walking / Q000193:education / Q000293:injuries*