Education versus environmental countermeasures

Is it really an either-or proposition? An important debate arose repeatedly during a recent interdisciplinary, international child pedestrian safety conference concerning the relative value of pedestrian education and skills training versus engineering modifications.1 Health educators and psychologists, particularly Drs Andrea Gielen from the United States and James Thomson from Scotland, acknowledged that, even though classroom education had not been particularly successful in improving pedestrian safety behavior among young children,2–4 skills training had strong merit. Crashes between child pedestrians and motor vehicles declined after classroom education, but the degree of pedestrian behavioral change was not large.5,6 By comparison, correct behavior for certain road crossing skills had increased up to 40%–70% among children exposed to skills training interventions in the United Kingdom,7,8 and to 30%–50% of lower elementary schoolchildren exposed to such training in the United States.9 This positive outlook could be described as “the cup being half full”. The other point of view (“the cup being half empty”) was presented by Drs Ian Roberts and Fred Rivara, who argued that no single educational program had demonstrated sufficient impact on the majority of students to merit endorsement and widespread dissemination. Indeed, a recent systematic review of community based education studies aimed at reducing child pedestrian injuries concluded that such programs have modest and limited benefit, and that “even after training, young children remain at substantial risk for pedestrian injuries”.10 One consequence of that position is to suggest abandoning any future attempt to educate or train children in street crossing, and in its place, to emphasize …