中学生道路交通事故危险因素及干预效果评价研究
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摘要
目的
描述中学生交通事故发生率及其流行特征,了解中学生道路交通安全知信行现状,探讨中学生道路交通事故的主要危险因素,并以交通安全知信行和交通事故发生密度为主要指标,评价中学生道路交通安全教育干预的近期和远期效果。
方法
整群抽取济南市7所中学在校学生为研究对象,自设调查问卷收集基线交通安全知信行数据,以及2005/01/01至2005/12/31交通事故信息。以SPSS 11.0软件分析该人群交通事故特征及其交通安全知信行现状,并采用Logistic回归分析初步探讨交通事故危险因素。
采用配对病例对照研究方法,以济南市11所中学在校学生为目标人群,选择其中2005/01/01～2005/12/31期间发生交通事故的116名学生为病例,以性别、年龄匹配且同期未发生事故的同班级学生为对照。收集两组学生基本信息、行为习惯、家庭条件、心理反应(速度估计、复杂反应和操纵机能)以及道路安全知信行数据,比较两组学生之间的差异,并以条件Logistic回归分析探讨各因素对交通事故的影响。
以基线调查7所中学的初一、初二、高一、高二学生为干预组,以合肥市某中学相同年级学生为对照组。对干预组和对照组进行基线和随访问卷调查,随访期间对干预组及干预城市所有中学生进行交通安全教育干预,比较基线和随访调查时干预组和对照组学生交通安全知信行的变化,以评价教育干预的近期效果。收集干预城市中学生干预前一年以及干预后6个月交通事故发生密度资料,进行前、后比较以评价干预的远期效果。
结果
基线调查结果显示中学生年交通事故发生率为2.3%,男女交通事故发生率之比为1.8∶1,交通事故发生密度约为25人次/1000人年。自行车事故在中学生交通事故中占重要地位(71%),但只有39%的人在骑车上马路之前专门学习过交通规则。交通事故伤害以轻微伤害为主,90%在门诊处理,仅有13%的事故由交警处理,8%的事故当事人得到保险理赔。
总体上,中学生对交通安全知识各方面有较好的了解,合格率在75%以上。90%的中学生认为交通安全教育很重要,70%认为交通安全教育是减少交通违章行为的最有效措施。在交通事故原因的认识上,60%中学生存在较高程度的自责心理,近80%学生认为中学生责任事故原因主要是不遵守交通规则。约10%的学生每周违反交通规则在5次以上,前三位常见的交通违章行为依次为骑自行车带人、闯红灯、边骑车边听耳机。性别和年级与交通安全知信行关系表现为女生知信行优于男生,随着年级的增高交通安全知识提高,但交通行为以及交通安全相关态度向相反方向发展,变得更差和更消极。
中学生交通违章行为尤其是骑自行车有关的交通违章行为和交通事故之间的关系密切,性别为男、上学途中过马路的次数多以及骑车相互追逐行为是中学生交通事故的主要危险因素,而认为中学生交通事故原因主要在于中学生自身是保护因素。
病例对照研究结果发现中学生年交通事故发生率约为0.91%,低于基线调查(2.28%)。和基线调查相比,事故发生后住院治疗的比例(23.1% vs 8.8%)、交警处理的事故比例(20.5%vs13.4%)、以及保险理赔的事故比例(15.6%vs8.8%)均有所增高。
在速度估计、复杂反应及操纵机能三项心理指标中,病例和对照之间速度估计差异有显著性,多因素条件Logistic回归分析显示速度估计(低估速度)是交通事故的主要风险因素。和对照组相比,病例组对待交通安全的态度更加消极,交通冒险行为尤其是骑自行车冒险行为更多。多因素条件Logistic回归分析结果显示,消极的交通安全态度以及交通违章行为尤其是骑自行车冒险行为是交通事故的主要危险因素。此外,家庭和学校之间的距离超过1000米也是交通事故的危险因素,而母亲文化程度高是保护因素。
干预效果评价研究发现,随访调查时干预组各项交通安全知识的平均得分和合格率比基线调查时有显著性提高,但对照组提高不明显;随访时两组学生的交通安全态度都趋向消极,但干预组的变化幅度较小,且有更多的学生将交通事故的原因归咎于中学生自身;随访期间两组学生每周违反交通规则的频率没有显著性变化,干预组3种违章行为有所改善,但2种行为变得更差,而对照组有1种行为有所改善,3种行为变得更差。干预后中学生交通事故发生密度没有显著性降低。
结论
中学生年交通事故发生率约为2%,男女之比1.8∶1,交通安全知信行特点表现为女生优于男生,随年级增高知识提高,但态度和行为变化相反。
交通安全态度和行为、速度估计、家庭和学校之间的距离、母亲文化水平是中学生交通事故的主要影响因素。和交通安全知识相比,交通行为以及对待交通安全的态度更加重要。中学生交通事故的预防控制不仅要以提高知识为基础,更重要的是培养积极的态度和安全的行为,尤其是安全骑车行为。
交通安全教育干预对提高中学生交通安全知识有明显作用,对改善中学生交通安全态度也体现出一定的积极作用,但对交通行为以及交通事故发生密度没有明显影响。交通安全教育干预应及早进行,探索新的更有效的教育干预方法是未来重要的研究方向。
Objective
To 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.
Methods
A 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.
Results
In 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.
Conclusion
The 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.
描述中学生交通事故发生率及其流行特征,了解中学生道路交通安全知信行现状,探讨中学生道路交通事故的主要危险因素,并以交通安全知信行和交通事故发生密度为主要指标,评价中学生道路交通安全教育干预的近期和远期效果。
方法
整群抽取济南市7所中学在校学生为研究对象,自设调查问卷收集基线交通安全知信行数据,以及2005/01/01至2005/12/31交通事故信息。以SPSS 11.0软件分析该人群交通事故特征及其交通安全知信行现状,并采用Logistic回归分析初步探讨交通事故危险因素。
采用配对病例对照研究方法,以济南市11所中学在校学生为目标人群,选择其中2005/01/01～2005/12/31期间发生交通事故的116名学生为病例,以性别、年龄匹配且同期未发生事故的同班级学生为对照。收集两组学生基本信息、行为习惯、家庭条件、心理反应(速度估计、复杂反应和操纵机能)以及道路安全知信行数据,比较两组学生之间的差异,并以条件Logistic回归分析探讨各因素对交通事故的影响。
以基线调查7所中学的初一、初二、高一、高二学生为干预组,以合肥市某中学相同年级学生为对照组。对干预组和对照组进行基线和随访问卷调查,随访期间对干预组及干预城市所有中学生进行交通安全教育干预,比较基线和随访调查时干预组和对照组学生交通安全知信行的变化,以评价教育干预的近期效果。收集干预城市中学生干预前一年以及干预后6个月交通事故发生密度资料,进行前、后比较以评价干预的远期效果。
结果
基线调查结果显示中学生年交通事故发生率为2.3%,男女交通事故发生率之比为1.8∶1,交通事故发生密度约为25人次/1000人年。自行车事故在中学生交通事故中占重要地位(71%),但只有39%的人在骑车上马路之前专门学习过交通规则。交通事故伤害以轻微伤害为主,90%在门诊处理,仅有13%的事故由交警处理,8%的事故当事人得到保险理赔。
总体上,中学生对交通安全知识各方面有较好的了解,合格率在75%以上。90%的中学生认为交通安全教育很重要,70%认为交通安全教育是减少交通违章行为的最有效措施。在交通事故原因的认识上,60%中学生存在较高程度的自责心理,近80%学生认为中学生责任事故原因主要是不遵守交通规则。约10%的学生每周违反交通规则在5次以上,前三位常见的交通违章行为依次为骑自行车带人、闯红灯、边骑车边听耳机。性别和年级与交通安全知信行关系表现为女生知信行优于男生,随着年级的增高交通安全知识提高,但交通行为以及交通安全相关态度向相反方向发展,变得更差和更消极。
中学生交通违章行为尤其是骑自行车有关的交通违章行为和交通事故之间的关系密切,性别为男、上学途中过马路的次数多以及骑车相互追逐行为是中学生交通事故的主要危险因素,而认为中学生交通事故原因主要在于中学生自身是保护因素。
病例对照研究结果发现中学生年交通事故发生率约为0.91%,低于基线调查(2.28%)。和基线调查相比,事故发生后住院治疗的比例(23.1% vs 8.8%)、交警处理的事故比例(20.5%vs13.4%)、以及保险理赔的事故比例(15.6%vs8.8%)均有所增高。
在速度估计、复杂反应及操纵机能三项心理指标中,病例和对照之间速度估计差异有显著性,多因素条件Logistic回归分析显示速度估计(低估速度)是交通事故的主要风险因素。和对照组相比,病例组对待交通安全的态度更加消极,交通冒险行为尤其是骑自行车冒险行为更多。多因素条件Logistic回归分析结果显示,消极的交通安全态度以及交通违章行为尤其是骑自行车冒险行为是交通事故的主要危险因素。此外,家庭和学校之间的距离超过1000米也是交通事故的危险因素,而母亲文化程度高是保护因素。
干预效果评价研究发现,随访调查时干预组各项交通安全知识的平均得分和合格率比基线调查时有显著性提高,但对照组提高不明显;随访时两组学生的交通安全态度都趋向消极,但干预组的变化幅度较小,且有更多的学生将交通事故的原因归咎于中学生自身;随访期间两组学生每周违反交通规则的频率没有显著性变化,干预组3种违章行为有所改善,但2种行为变得更差,而对照组有1种行为有所改善,3种行为变得更差。干预后中学生交通事故发生密度没有显著性降低。
结论
中学生年交通事故发生率约为2%,男女之比1.8∶1,交通安全知信行特点表现为女生优于男生,随年级增高知识提高,但态度和行为变化相反。
交通安全态度和行为、速度估计、家庭和学校之间的距离、母亲文化水平是中学生交通事故的主要影响因素。和交通安全知识相比,交通行为以及对待交通安全的态度更加重要。中学生交通事故的预防控制不仅要以提高知识为基础,更重要的是培养积极的态度和安全的行为,尤其是安全骑车行为。
交通安全教育干预对提高中学生交通安全知识有明显作用,对改善中学生交通安全态度也体现出一定的积极作用,但对交通行为以及交通事故发生密度没有明显影响。交通安全教育干预应及早进行,探索新的更有效的教育干预方法是未来重要的研究方向。
Objective
To 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.
Methods
A 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.
Results
In 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.
Conclusion
The 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.
引文
1.全国人大法工委员行政法室编《.中华人民共和国道路交通安全法》.北京:人民交通出版社.
2.邓世雄,赵新才.中国道路交通事故流行趋势与特征.重庆医学, 2004;33(7): 1074-1076.
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2.邓世雄,赵新才.中国道路交通事故流行趋势与特征.重庆医学, 2004;33(7): 1074-1076.
3. Manciaux M, Romer CJ.儿童和青少年的意外事故研究的作用(李玉梅等译).北京:人民卫生出版社, 1993: 9-25.
4. Dowd MD, Keenan HT, Bratton SL. Epidemiology and prevention of childhood injuries. Crit Care Med, 2002; 30(1suppl): S385-92.
5. Schieber RA, Vegega ME. Reducing childhood pedestrian injuries. Inj Prev. 2002 Jun;8 Suppl 1: 1-10.
6. Crossman DC. The history of injury control and the epidemiology of child and adolescent injuries. Future, 2000; 10(1): 23-52.
7.范开辉,肖翠勤,芮东升,等.石河子地区3～12岁儿童交通伤害分析.中国学校卫生, 2005; 26(8): 689-690.
8.韩晓军,朱静,蒋庭魁,等.浙江省1995～1998年0～14岁儿童意外伤害死亡分析.疾病监测, 1999; 14(11):428-429.
9.张佩斌,陈荣华,邓静云,等.江苏省1994～1995年0～14岁儿童意外死亡前瞻性调查.中华流行病学杂志, 1998; 19(5): 290-293.
10.杨功焕,周脉耕,黄正京,等.中国人群1991～2000年伤害死亡的流行趋势和疾病负担.中华流行病学杂志, 2004; 25(3):193-198.
11. Perel P, McGuire M, Eapen K, et al. Research on preventing road traffic injuries in developing countries is needed. BMJ, 2004; 328(7444): 895.
12.张胜年,卢伟周,顺福,等.上海市2000~2002年道路交通事故伤害流行病学研究.中华流行病学杂志, 2004; 25(3): 199-203.
13.牟振云,罗荣,赵春香,等.急诊交通伤害病例特点及死亡影响因素分析.预防医学论坛, 2004; 10(6): 646-647.
14.池桂波,王声涌,刘润幸.我国道路伤害与交通环境因素关系的流行病学分析.中华流行病学杂志, 2000; 21(5): 330-332.
15.王旭霞,何庚声,郝爱华,等.甘肃省中小学生道路交通伤害流行病学分析.疾病监测, 2004; 19(9):353-355.
16.曹云生,徐永范,黄靖波.奉化市疾病监测点人群意外伤害的流行病学分析.海峡预防医学杂志, 2002; 8(4): 43-45.
1王正国,尹志勇,肖凯.我国2002～2003年的道路交通事故.中华创伤杂志, 2004; 20(11): 641-644.
2韩晓军,朱静,蒋庭魁,等.浙江省1995～1998年0～14岁儿童意外伤害死亡分析.疾病监测, 1999; 14(11):428-429.
3张佩斌,陈荣华,邓静云,等.江苏省1994～1995年0～14岁儿童意外死亡前瞻性调查.中华流行病学杂志, 1998; 19(5): 290-293.
4王旭霞,何庚声,郝爱华,等.甘肃省中小学生道路交通伤害流行病学分析.疾病监测, 2004; 19(9): 353-355.
5黄淳,赵建华,孟宁,等.宁夏回、汉族中小学生伤害的流行病学特征分析.中华流行病学杂志, 2001;22(4): 252-255.
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