Pedestrian Injuries on the Rise for Teens on Cell Phones

Neil Osterweil

November 26, 2013

BOSTON — There has been a recent upswing in injuries in older teens, probably because they are paying more attention to their cell phones than to where they are going.

That is the contention of investigators from Safe Kids Worldwide, a global nongovernmental organization dedicated to preventing injuries, the leading cause of death in children in the United States.

A Safe Kids recent study showed that distracted walking is as serious a public safety issue as distracted driving, Kristin Rosenthal, program manager for pedestrian and bike safety at that organization, told Medscape Medical News.

"We did observations at middle schools and high schools of kids crossing the street, and we observed 34,000 kids walking. We found that 1 in 5 high schoolers and 1 in 8 middle schoolers were distracted by some kind of electronic device while crossing the street," she said.

The most frequent distracted behaviors were texting (39% of observations) and the use of headphones (39%). Girls were more frequently seen walking while distracted than boys, but the pedestrian death rate for boys is 1.8 times higher than for girls.

Rosenthal and her colleague at Safe Kids Worldwide, Angela Mickalide, PhD, examined 1995 to 2010 data on pedestrian deaths from the National Highway Traffic Safety Administration Fatality Analysis Reporting Systems database and on nonfatal injuries from the General Estimates System.

The study results were presented here at the American Public Health Association 141st Annual Meeting.

We've had a pretty big drop in the number of little kids we see and a pickup in the teenagers.

From 1995 to 2009, there was a 53% decline in the pedestrian death rate and a 44% decline in the injury rate. However, in 2009 and 2010, there was an uptick in deaths and in injuries.

"Interestingly, the most at-risk age group has shifted since 1995 when 5 to 9 year olds sustained the most injuries, to today when teens are at greatest risk. The death rate among older teens is now twice that of younger children," the investigators report.

They saw a 25% increase in injuries in 16 to 19 year olds over the previous 5 years, and 14 to 19 year olds currently account for half of all child pedestrian injuries.

Table. Change in Injury Rates From 2001–2005 to 2006–2010

Age Group (Years) Percent Change
1–4 –31
5–9 –34
10–15 –16
16–19 +25


The investigators speculate that "the rapid increase in the use of cell phone and other technologies while walking in this age group may be responsible for this increase."

Member institutions of the Safe Kids coalition interviewed 2441 preteens and teens about their walking behaviors. In all, 49% said they used a cell phone while walking, 40% said they used an mp3 player, and 6% said they used another mobile device, such as a handheld game console.

But as is typical for adolescents, 78% said that the group most at risk for pedestrian injuries was either younger than they were (50%) or older than they were (28%). Only 22% said their own age group was the most at risk.

The investigators recommend that parents and guardians talk to teens about the dangers of distracted walking, and advise them to stop using mobile devices while crossing the street. They recommend starting the message when the child gets his or her first mobile device, modeling good street-crossing behavior, and urging their children to speak up when they see someone walking distractedly.

David Mooney, MD, director of the trauma program at Boston Children's Hospital, who was not involved in this study, told Medscape Medical News that he frequently sees kids who have been injured in pedestrian accidents due to inattention.

"What we see kind of mirrors what the folks from Safe Kids saw. We've had a pretty big drop in the number of little kids we see and a pickup in the teenagers," he said.

Dr. Mooney reported that he has treated patients who were injured after walking into the road and getting hit by a car, although patients are often reluctant to admit that they haven't been paying attention, whether because of a mobile device or other distraction. "I certainly have seen cases where people got hit because they were on the phone," he said.

Dr. Mooney said he has also treated patients who were injured walking into poles on sidewalks when their attention was elsewhere.

He noted that pedestrian injuries in kids are particularly problematic in areas where there is no sidewalk and children are forced to walk in the street.

"If you're in a street, or crossing a street, it's really a bad idea to not be paying attention," Dr. Mooney said.

Safe Kids Worldwide is supported by private donations and by corporate partners Johnson & Johnson, Bell Sports, General Motors, and FedEx. Ms. Rosenthal and Dr. Mooney have disclosed no relevant financial relationships, although Ms. Rosenthal is an employee of Safe Kids.

American Public Health Association (APHA) 141st Annual Meeting: Abstract 287877. Presented November 3, 2013.


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