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High risk of child pedestrian deaths at Halloween

US results highlight opportunities for year-round action to make residential streets safer for pedestrians

Louise Prime

Wednesday, 31 October 2018

Halloween is associated with an increased risk of pedestrian fatalities in the US, especially among children, according to the authors behind an investigation of more than four decades of national data. They said their results*, published in JAMA Pediatrics, highlight opportunities for year-round action to make residential streets safer for pedestrians, and should not lead to calls for trick-or-treating to be abolished.

The authors pointed out that trick-or-treating at Halloween, when children walk door to door to collect sweets from neighbours, might heighten pedestrian traffic risk because of several factors: the celebrations occur at dusk, face masks restrict peripheral vision, costumes limit visibility, and street-crossing safety might be neglected; and in addition, some adult partygoers are impaired by alcohol. Because previous studies of Halloween traffic risks have been limited to brief observations, failed to test for statistical significance, and/or lacked appropriate control groups, they wanted to systematically evaluate pedestrian fatality risks on Halloween – so they examined 42 years of data from the National Highway Traffic Safety Administration’s Fatality Analysis Reporting System.

They compared the number of pedestrian fatalities that occurred between 17:00 and 23:59 on 31st October each year with the number that occurred during the same hours on control evenings one week earlier (24th October) and one week later (7th November). They used exact binomial tests to examine the significance of deviations from the expected ratio of 1:2, and they evaluated hourly variation in risk by stratifying pedestrian fatalities by clock time.

The researchers reported that a total of 608 pedestrian fatalities occurred on the 42 Halloween evenings, compared with 851 pedestrian fatalities occurred on the 84 control evenings; and that absolute mortality rates averaged 2.07 and 1.45 pedestrian fatalities per hour, respectively.

Compared with control evenings, the relative risk of a pedestrian fatality overall was 43% higher on Halloween, equivalent to four additional pedestrian deaths on an average Halloween (odds ratio OR, 1.43). However, children aged four to eight years had a 10-fold increase in pedestrian fatality risk on Halloween (OR 10.00). Risks for overall pedestrian fatalities, both on Halloween and the other nights studied, peaked at about 18:00.

The authors noted that both on Halloween and throughout the year, most childhood pedestrian deaths occurred within residential neighbourhoods. They commented that such events “highlight deficiencies of the built environment” such as lack of pavements and unsafe street crossings, as well as shortcomings in public policy (such as inadequate play space) and failures in traffic control (such as excessive speed). They argued that although traffic calming on Halloween might prevent child pedestrian deaths – and pedestrian visibility could be improved by limiting on-street parking and incorporating reflective patches into clothing – restricting these interventions to just one night per year “misses the point” because effective traffic safety interventions all year round would foster much greater progress toward completely eliminating pedestrian fatalities.

They concluded: “Halloween trick-or-treating encourages creativity, physical activity, and neighbourhood engagement. Trick-or-treating should not be abolished in a misguided effort to eliminate Halloween-associated risk. Instead, policymakers, physicians, and parents should act to make residential streets safer for pedestrians on Halloween and throughout the year.”

*Staples JA, Yip C, Redelmeier DA. Pedestrian fatalities associated with halloween in the United States. JAMA Pediatr. Published online October 30, 2018. doi:10.1001/jamapediatrics.2018.4052.

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