| ObjectiveTo reveal the magnitude of RTAs (road traffic accidents) among middle school students, and demonstrate the current status of their KAB (knowledge, attitude and behavior) on road safety. To explore risk factors for RTAs, and evaluate the intervention effects for RTAs prevention among middle school students, with KAB on road safety as indicators for near future effects and incidence density of RTAs for long-term effects.MethodsA cross-sectional baseline study was conducted among 7 middle schools in Ji'nan City, where the students were chosen as a cluster sample. Self-designed questionare was used to collect the KAB on road safety of these students together with the information of RTAs incurred to them from January 1st to December 31st, 2005. Characteristics of RTAs and KAB on road safety of these children were analyzed, and losigtic regression was performed to explore the risk factors for RTAs.A 1∶1 matched case-control study was designed to analyse risk factors for RTAs. Cases and controls were from 11 middle school students in Ji'nan City. Case group was consisted of 116 students inccured RTA from 2005/01/01 to 2005/12/31. Controls were 116 students from the same class of the cases and matched by age and gender. Data of demography, behavior and habit, family conditions, psychological reaction ability (include speed anticipation, discrimination reaction and action judgment) and KAB on road safety of cases and controls were collected and compared. Conditional logistic regressions were conducted to analyze the relationship between these factors and RTAs.Students in Grade 1 and Grade 2 from the 7 junior and senior middle schools of baseline study were selected as intervention group, and students in Grade 1 and Grade 2 from a middle school in Hefei City as control group. Baseline and follow-up investigation were conducted in both groups. Education intervention was conducted in the intervention group and all the middle school students in Ji'nan City. Changes of KAB on road safety were detected for both groups during follow-up period, and comparison of KAB for the two groups were done by statistical analysis. Incidence density of RTA for the entire middle school students in Ji'nan City in the previous year of intervention and 6 months after intervention were collected and compared to reflect long-term effects of the intervention.ResultsIn baseline study, the incidence rate of RTA was 2.3% per year for middle school students, with a ration of 1.8∶1 for male vs female, and incidence density of RTAs was about 25 per 1000 person-year. Bicycle accident played an important role in RTAs (about 70%), while only 39% students learned traffic regulations intensively before they normally ride bicycle to school. Most of the RTIs were light injuries, with 90% treated in out patient. Only 13%RTAs were handled by traffic policeman, and about 8% of them obtained compensation from medical insurance.Most middle school students well understood road traffic safety knowledge, and the qualified rate was more than 75%. 90% admitted road safety education was very essential, and 70% believed it was the most effective measure for RTA prevention. As to the main cause of RTA, 60% admitted middle school students themselves should be responsible for RTAs (reflected self-accusation), and about 80% reported violations of traffic rules was the essential cause of accident due to middle school students. 10% violated traffic rules more than 5 times a week. The three main violations of road traffic law were carrying person, ignoring the traffic-control signals, and wearing Walkman when riding. Female students performed better than male students in KAB. Knowledge on road safety showed an increasing tendency with grade; however, attitude and behavior reflected the adverse tendency, i.e. became more negative and even worse with grade.There was a significant association between traffic rules violation (especially for bicycle ride violation) with RTA for middle school students. Male, more road crossing times from home to school, and chasing riding were the main risk factors for RTAs, while the attitude of self-accusation on the cause of RTA was a protective factor. The case-control study showed the incidence rate of RTA was 0.91% per year for middle school students, much lower than baseline study (2.28%). The percentages of hospitalized(23.1%vs8.8%), handled by traffic policeman(20.5 % vs13.4 % ), and insurance compensation(15.6%vs8.8%) were increased as compared with the baseline study.Of the three psychological reaction indices, there existed significant difference on speed anticipation between cases and controls. Compared with the controls, more cases showed negative attitude and risk-taking–behavior especially in riding bicycle. Multiple variate conditional logistic regression analysis showed speed anticipation (underestimated speed), negative attitude, and risk-taking–behavior, were the main risk factors for RTAs. In addition, distance from home to school more than 1000 meters was a risk factor for RTAs, while high maternal education was a protective factor.During the follow-up period, mean scores and qualified rates of road safety knowledge for intervention group improved significantly, while these indices changed less for control group. Attitude to road safety turned negative for both groups, however, the intervention group showed less than the control group, and more students in the intervention group admitted middle school students themselves should be responsible for RTAs (self-accusation). Frequency of traffic rules violation per week did not decreased during followed-up period for the both groups. Although there were 3 kinds of traffic rules violation improved in intervention group, and 1 improved in control group, there were still 2 kinds turned worse in the intervention group, and 3 kinds in control group. Incidence density of RTAs in middle school students did not significantly decreased after intervention.ConclusionThe incidence rate of RTA was about 2% for middle school students, and the ratio for male vs female was 1.8∶1. The female students performed better than the male students in KAB on road safety. Knowledge showed an increasing tendency with grade; however, attitude and behavior went the adverse tendency.Road safety attitude and behavior, speed anticipation, distance from home to school, and maternal education, were the main influence factors for RTAs among middle school students. Attitude and behavior were much more important than knowledge in road safety, and it is much more important to improve road safety attitude and behavior than enhance knowledge for prevention and control of RTAs among middle school students, especially for culturing safe riding behavior.Road safety education significantly improved the knowledge for middle school students; and exerted positive effects in road safety attitude to some extent. However, no significant effect was found for improving the children's behavior, and the incidence density of RTAs did not significantly decrease after intervention. Road safety education should be carried out in the early stage of childhood, and to explore new and effective intervention methods is a priority of this field in the future. |
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