Accident Analysis and Prevention 38 (2006) 1064–1070 Risk of vehicle–pedestrian and vehicle–bicyclist collisions among children with disabilities Huiyun Xiang a,d,* , Motao Zhu b , Sara A. Sinclair a , Lorann Stallones c , J.R. Wilkins III d , Gary A. Smith a a Center for Injury Research and Policy, Columbus Children’s Research Institute and Children’s Hospital, 700 Children’s Drive Columbus, OH 43205, USA b Department of Epidemiology and Biostatistics, State University of New York at Albany, New York, USA c Colorado Injury Control Research Center, Colorado State University, CO, USA d Division of Epidemiology, College of Medicine and School of Public Health, The Ohio State University, OH, USA Received 18 January 2006; received in revised form 7 March 2006; accepted 15 April 2006 Abstract Objectives: To examine the potential association between disability and risk of vehicle–pedestrian and vehicle–bicyclist collisions among children. Methods: Data from the 2002 National Transportation Availability and Use Survey for Persons with Disabilities (NTAUSPD) were analyzed. Results: Among 5019 persons who completed the survey, there were a total of 687 children between 5–17 years of age, including 299 respondents with and 388 without disabilities. After controlling for potential confounding variables, children with disabilities were more than five times more likely to have been hit by a motor vehicle as a pedestrian or bicyclist than children without disabilities (adjusted OR = 5.53, 95% confidence interval (CI): 1.43–21.41). For all children, regardless of their disability status, children who reported having some difficulty with traffic had a significantly higher risk of collisions (adjusted OR = 50.71, 95% CI: 7.35–349.86). The most commonly reported traffic difficulties for all children with and without disabilities were “Too few or missing sidewalks/paths,” “Do not know when it’s safe to cross,” and “Insensitive/unaware drivers.” Conclusions: Existing effective transportation safety interventions should be effective in reducing the risk of vehicle–pedestrian and vehicle–bicyclist collisions in children with disabilities. Future research and safety interventions should focus on how to promote the use of existing effective transportation safety interventions among children with disabilities and their families. © 2006 Elsevier Ltd. All rights reserved. Keywords: Children; Pedestrians; Cyclists; Injury Prevention; Vehicle; Disabilities 1. Introduction Vehicle–pedestrian and vehicle–bicyclist injuries among children are important causes of morbidity and mortality around the world (Peden, 2005; Roberts, 1993). In the U.S., approx- imately 500 children were killed in vehicle–pedestrian or vehicle–bicyclist collisions in 2004, and nearly 30,000 chil- dren aged 14 years or less were treated in hospital emergency departments for injuries resulting from these collisions (National Highway Traffic Safety Administration, 2005). The total annual cost of pedestrian death and injury among children was an esti- mated US$ 5.2 billion in the U.S. in 2002 (Worldwide Safe Kids, 2005). * Corresponding author. Tel.: +1 614 355 2768; fax: +1 614 722 2448. E-mail address: xiangh@pediatrics.ohio-state.edu (H. Xiang). Previous research has identified multiple risk factors involved in vehicle–pedestrian and vehicle–bicyclist collisions, including type and structure of vehicles (Ballesteros et al., 2004), environ- mental and social profile of the collision sites (Bergman et al., 2002; Macpherson et al., 1998; Pless et al., 1987; Posner et al., 2002; Rivara, 1990), behavior of drivers (Zajac and Ivan, 2003), and physical and cognitive abilities of pedestrians/bicyclists (Roberts and Norton, 1995). The physical and cognitive abil- ities of the pedestrians and bicyclists are especially important to consider for children with disabilities. National data indicate that about 9.4 million children in the U.S. have disabilities (U.S. Department of Health and Human Services, 2005), and chil- dren with disabilities are found to face a significantly higher injury risk because of their impaired physical or cognitive abil- ities (Gaebler-Spira and Thornton, 2002; Petridou et al., 2003; Ramirez et al., 2004; Xiang et al., 2005a). However, when pre- vention approaches for vehicle–pedestrian and vehicle–bicyclist 0001-4575/$ – see front matter © 2006 Elsevier Ltd. All rights reserved. doi:10.1016/j.aap.2006.04.010