Escolar Documentos
Profissional Documentos
Cultura Documentos
burns account for most fatal injuries; falls and bicycle and
pedestrian crashes are responsible for most nonfatal injuries.2
In addition, children who live in poverty are at greater risk for
injury and live in environments where they are simultaneously exposed to multiple safety hazards.3 There is evidence
that risky behaviors increase with age in school-aged children
and that children who have a history of injuries are more
likely to report risky behaviors.4
Schools are a constant and important part of childrens
lives and an obvious venue for teaching safety behaviors.
School-based interactive injury prevention programs have
reported positive results in improved knowledge among students in areas of bike and pedestrian safety, falls, playground
safety, fire safety, and poisoning when compared with traditional methods of instruction.57 This is consistent with literature that has shown shorter periods of time spent in more
active learner-to-learner interactions are more productive
than longer periods of more passive teacher-driven sessions.8
Successful injury prevention education has occurred
through multifaceted approaches that include hands-on learning, visual aids, creative writing, and verbal interaction.
Inquiry-based instruction allows children to develop critical
reasoning skills, superior to declarative methods where children are simply provided with the correct answer.9 One
mobile safety center reported that their mobile nature offered
them the ability to provide urban families greater access to
personalized, low-cost injury prevention education.10
Our mobile safety street (MSS) is an injury prevention
program that seeks to incorporate proven effective strategies to
enhance the learning of safety behaviors of fifth-grade students.
It is a mobile exhibit that travels to the schools, maximizing
efficiency in the students school day and creating a familiar
environment in which students learn. The MSS curriculum has
been developed to parallel the safety and health curriculum that
is required by the Department of Education in Massachusetts. It
uses a hands-on, learner-centered method of instruction best
suited to the learning style of grade school boys and girls. The
purpose of this project is to test the effectiveness of the MSS
curriculum and compare it with a traditional classroom safety
curriculum among grade 5 elementary school children.
The Journal of TRAUMA Injury, Infection, and Critical Care Volume 71, Number 5, November Supplement 2, 2011
S505
Manno et al.
The Journal of TRAUMA Injury, Infection, and Critical Care Volume 71, Number 5, November Supplement 2, 2011
Figure 1. Learning stations at MSS. (A) Urban pedestrian safety, (B) suburban pedestrian safety, (C) home safety, and (D)
bus safety.
Coalition for Kids (IFCK) in Worcester, MA. The MSS curriculum was adapted from the standard classroom health curriculum used by Worcester Public Schools, the Michigan Model for
Comprehensive School Health Education. The same safety information was taught in two different waysat MSS and in the
classroom. This study was designed to compare the effectiveness of the hands-on MSS curriculum in improving and retaining safety knowledge with what is achieved through the standard
classroom health education. The MSS curriculum uses applied
S506
The Journal of TRAUMA Injury, Infection, and Critical Care Volume 71, Number 5, November Supplement 2, 2011
Survey Design
We developed a 14-question survey that focused on
important safety behaviors emphasized in both the schoolbased and MSS curricula. The evaluation tool from the
Michigan Model is available in open-ended question format
only. We adapted this tool and created multiple choice questions. For example, the Michigan Model evaluation regarding
calling 911 asks the student to describe how to make an
emergency phone call. A correct student response would be
to dial 911, state his or her name and address, and tell the
nature of the emergency. We adapted this on the survey as
multiple choice question 5 (Fig. 3).
Study Design
This study followed a randomized block design. The 33
elementary schools in the Worcester Public School system
were placed in homogenous blocks based on socioeconomic
and demographic data reported by each school. The percentage of enrolled students who are eligible for government
subsidized lunch was the primary criterion and served as a
proxy for household income. Using this criterion, the 33
elementary schools were matched into 16 pairs, excluding 1
school because the reported demographic and socioeconomic
data were widely divergent from the other schools. A discrepancy of 10% in the criterion was determined as an
2011 Lippincott Williams & Wilkins
All grade 5 students (n 1,692) were asked to participate in the study as either the intervention group (who
received the MSS experience) or the comparison group (who
received traditional classroom safety education). Before receiving MSS, each child in the intervention group took a
written safety knowledge survey. During the next health
class, each student participated in the MSS 30-minute to
40-minute curriculum. Students completed a written safety
knowledge survey immediately after participating in MSS to
assess changes in their safety knowledge. Six months later,
students completed a follow-up survey to evaluate retention
of safety knowledge following their MSS experience. Students in the comparison group completed a baseline survey at
the same time as the intervention group. They participated
in their regularly scheduled health class and safety curriculum. They took a follow-up survey after the completion of the
traditional classroom safety education curriculum. After the
S507
Manno et al.
The Journal of TRAUMA Injury, Infection, and Critical Care Volume 71, Number 5, November Supplement 2, 2011
Data Analysis
Descriptive statistics were calculated to establish a
baseline evaluation of intervention and comparison groups.
Variables include gender, socioeconomic status as determined by eligibility for free and reduced lunch, and age for
each of the intervention and comparison groups. Also recorded were the total number of students who completed each
survey and their mean score, with its associated 95% confidence interval.
A two-way analysis of variance (ANOVA) was then
performed to compare means (grade of 10) within groups,
adjusting for gender and age. Log transformation was performed to account for the lack of normality for the measured
outcome. Success rates for each question were compared
separately for boys and girls and between tests using a 2
analysis. Ninety-five percent confidence intervals were constructed around differences between means and percentages.
RESULTS
Inspection of baseline values of gender, age, and socioeconomic status showed that the intervention and comparS508
The Journal of TRAUMA Injury, Infection, and Critical Care Volume 71, Number 5, November Supplement 2, 2011
TABLE 1.
Variable
Gender (% males)
Age of males
(yr, mean, 95% CI)
Age of females
(yr, mean, 95% CI)
Social economic status, % eligible for government subsidy
Intervention Group
n1415
Comparison Group
n155
P*
50.5
44.5
0.10
10.09 10.0010.18
10.26 10.1810.34
10.48 10.3710.59
60.8
10.52 10.3810.66
65.7
0.023
Thirty-four students from the intervention group and one student from the non-intervention group did not indicate their gender.
TABLE 2.
Test Group
At baseline
After MSS intervention
6 months after MSS
intervention
School curriculum
(comparison)
1354
425
336
5.67 5.565.80
7.43 7.167.71
7.34 7.047.66
154
6.48 6.106.89
TABLE 3.
in Score)
DISCUSSION
Males
Females
1.28 1.211.36
1.30 1.231.37
1.22 1.131.31
1.26 1.191.34
1.04 0.951.16
0.86 0.800.93
1.23 1.101.34
1.12 1.021.22
with and without intervention or before and after intervention. Girls answers to question 4 show a significant increase
in correct responses between baseline and intervention (percent change 36.2%, p 0.001), a slight decrease between
intervention and the testing done 6 months later (percent
change 4.0%, p 0.098), and all results are significantly
higher than for the comparison school curriculum program
(percent change 16.4% between baseline and school program, p 0.004; 21.2% between the intervention and the
school curriculum, p 0.001; and 15.8% between the 6
months postintervention evaluation and the school curriculum, p 0.002). Boys answers to question 4 followed the
same pattern. Answers to questions 2, 3, and 12 also show the
same trend for both boys and girls.
Girls responses to question 3 show no change in
correct responses between baseline and intervention (percent
change 5.3%, p 0.157), a slight increase between
2011 Lippincott Williams & Wilkins
Manno et al.
The Journal of TRAUMA Injury, Infection, and Critical Care Volume 71, Number 5, November Supplement 2, 2011
S510
CONCLUSION
MSS is an innovative, interactive, and effective approach to teaching safety behaviors. The positive results
seen in this study suggest that mobile safety units such as
MSS are an important way to impart knowledge about
safety behaviors to grade school students living in lowincome urban environments where children are at the
greatest risk of injury.
REFERENCES
1. Available at: http://www.cdc.gov/Injury/publications/FactBook/Introduction2006-a.pdf.
2. Schnitzer PG. Prevention of unintentional childhood injuries. Am Fam
Physi. 2006;74:1864 1869.
3. Chaudhari VP, Srivastava RK, Moitra M, Desai VK. Risk of domestic
accidents among under five children. Internet J Fam Pract. 2009;7:122.
4. Morrongiello BA, Cusimano M, Orr E, et al. School-age childrens
safety attitudes, cognitions, knowledge, and injury experiences: how do
these relate to their safety practices? Inj Prev. 2008;14:176 179.
5. Kendrick D, Groom L, Stewart J, Watson M, Mulvaney C, Casterton R.
Risk Watch: cluster randomized controlled trial evaluating an injury
prevention program. Inj Prev. 2007;13:9398.
6. Greene A, Barnett P, Crossen J, Sexton G, Ruzicka P, Neuwelt E.
Evaluation of the THINK FIRST for KIDS injury prevention curriculum
for primary students. Inj Prev. 2002;8:257258.
7. Hotz G, Kennedy A, Lutfi K, Cohn SM. Preventing pediatric pedestrian
injuries. J Trauma. 2009;66:14921499.
8. Haidet P, Morgan RO, OMalleey K, Moran BJ, Richards BF. A
controlled trial of active versus passive learning strategies in a large
group setting. Adv Health Sci Edu. 2004;9:1527.
9. Lawson AE. What can developmental theory contribute to elementary
science instruction. J Elemen Science Edu. 2008;20:114.
10. Gielen AC, Mcdonald E, Frattaroli S, et al; CARES (Children ARE
Safe) Mobile Safety Center Partnership. If you build it, will they
come? Using a mobile safety centre to disseminate safety information and products to low-income urban families. Inj Prev. 2009;15:
9599.
11. Towner E, Dowswell T. Community-based childhood injury prevention
interventions: what works? Health Promot Internat. 2002;17:273284.
12. Azeredo R, Stephens-Stidham S. Design and implementation of injury
prevention curricula for elementary schools: lessons learned. Inj Prev.
2003;9:274 278.
13. Bonomo V. Gender matters in elementary education: research-based
strategies to meet the distinctive learning needs of boys and girls. Educ
Horiz. 2010;88:257264.