title: School environments and social risk factors for child pedestrian-motor vehicle collisions: A case-control study.
abstract: BACKGROUND
  Child pedestrian-motor vehicle collisions (PMVCs) have decreased in Canada in the past 20 years. Many believe this trend is explained by the rise in automobile use for all travel. Initiatives to increase walking to school need to consider PMVC risk. Potential risk factors related to walking to school, the built environment and social factors were examined for schools with historically high child PMVC rates.
  
  
  METHODS
  Child PMVCs (age 4-12 years) from 2000 to 2013 and built environment features were mapped within school attendance boundaries in the City of Toronto, Canada. Case and control schools were in the highest and lowest PMVC quartiles respectively. Observational counts of travel mode to school were conducted. Logistic regression evaluated walking to school, built environment and social risk factors for higher PMVC rates, stratified by geographic location (downtown vs. inner suburbs).
  
  
  RESULTS
  The mean PMVC rates were 18.8/10,000/year (cases) and 2.5/10,000/year (controls). One-way street density (OR=4.00), school crossing guard presence (OR=3.65) and higher social disadvantage (OR=1.37) were associated with higher PMVCs. Higher residential land use density had a protective effect (OR=0.56). More walking was not a risk factor. While several built environment risk factors were identified for the inner suburbs; only social disadvantage was a risk factor within older urban neighbourhoods.
  
  
  CONCLUSIONS
  Several modifiable environmental risk factors were identified for child PMVCs. More walking to school was not associated with increased PMVCs after controlling for the environment. School social disadvantage was associated with higher PMVCs with differences by geographic location. These results have important implications for the design of roadways around schools.
authors: Faculty of Health-School of Kinesiology & Health Science York University, Norman Bethune College, 4700 Keele St., Room 337 Toronto, ON M3J 1P3, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Ave., Toronto M5G 1X8, Canada. Electronic address: lrothman@yorku.ca.
authors: Linda
authors: L
authors: Rothman
authors: Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Ave., Toronto M5G 1X8, Canada. Electronic address: andrew.howard@sickkids.ca.
authors: Andrew
authors: A
authors: Howard
authors: Department of Geography, University of Toronto Mississauga, 3359 Mississauga Road, SB3104, Mississauga, ON L5L 1C6, Canada. Electronic address: ron.buliung@utoronto.ca.
authors: Ron
authors: R
authors: Buliung
authors: Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Ave., Toronto M5G 1X8, Canada. Electronic address: colin.macarthur@sickkids.ca.
authors: Colin
authors: C
authors: Macarthur
authors: Faculty of Health-School of Kinesiology & Health Science York University, Norman Bethune College, 4700 Keele St., Room 337 Toronto, ON M3J 1P3, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Ave., Toronto M5G 1X8, Canada. Electronic address: sarah.a.richmond@gmail.com.
authors: Sarah A
authors: SA
authors: Richmond
authors: Faculty of Health-School of Kinesiology & Health Science York University, Norman Bethune College, 4700 Keele St., Room 337 Toronto, ON M3J 1P3, Canada. Electronic address: alison3@yorku.ca.
authors: Alison
authors: A
authors: Macpherson
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D000368:Aged; D001336:Automobiles; D002170:Canada; D016022:Case-Control Studies; D002648:Child; D004779:Environment Design; D005260:Female; D006801:Humans; D008297:Male; D000069636:Pedestrians / Q000706:statistics & numerical data*; D012111:Residence Characteristics; D018570:Risk Assessment / Q000379:methods*; D012574:Schools; D016138:Walking / Q000293:injuries*
keywords: Built environment; Children; Injuries; Pedestrian collisions; Prevention; Schools