Casie Morgan

Objective Over 7,000 American children die from pedestrian injuries annually, and pedestrian injury ranks among the top 5 causes of unintentional child death. Prevention efforts are multifaceted. One strategy, use of virtual reality (VR) to teach children to cross streets, is of growing interest to public health practitioners. The present study is a systematic review and meta-analysis that examined the efficacy of using VR to teach children pedestrian safety. Methods Following PRISMA guidelines, searches among 7 databases were completed, followed by abstract/full-text screening and data extraction. Hedge’s g was computed for the effect sizes of 3 outcomes: pedestrian knowledge, pedestrian-relevant cognition (attention to traffic, time to contact, start delay), and pedestrian behaviors (safe crossings, unsafe crossings). Risk of bias was assessed using Cochrane guidelines. Meta-regression analyses and subgroup analyses were conducted including 3 moderators: age, sex, and immersion level. Results A total of 20 studies, reported in 24 articles, were included in the qualitative analysis. Meta-analysis of the 12 studies with sufficient quantitative data available showed a statistically significant medium effect of VR safety interventions on child pedestrian knowledge and behavior. Mixed results emerged for the effect of VR safety interventions on children’s pedestrian-relevant cognition. Age and sex moderated the effect of VR training on pedestrian knowledge. Conclusions This synthesis of the literature on pediatric VR pedestrian safety interventions suggests an overall beneficial impact of VR interventions to teach children how to cross streets safely. Efforts should continue to develop and disseminate effective VR interventions. Registration ID CRD42022309352

Objective The preschool years represent a stage of rapid human development, hallmarked by exploring the environment through gross and fine motor movement and imaginative pretend play. This exploration is developmentally appropriate but also presents risks for injury, the leading cause of death for preschool-aged children. Common injuries reflect exploration and risk-taking exhibited during play, and play may be particularly risky when children imitate risky models like superheroes. Frequent exposure and subsequent identification with superheroes are concerning because the media glorifies superheroes, creating social learning effects on children and promoting play situations where children may attempt superhuman abilities and hurt themselves. This study examined the relations between pretend play, superhero identification, and children’s risk-taking. Methods One hundred five children aged 4–5 years old were randomly assigned to either a superhero- or school-themed, story-based protocol. In both conditions, children engaged in three identical behavioral tasks to assess risk-taking. Identification with superheroes was measured using parent-report questionnaires and child interviews. Results Pretending to be a superhero was not associated with increased risk-taking behavior acutely, but identification with superheroes was associated in some analyses with preschool children’s broader risk-taking behavior. Across risk-taking behavior tasks, children with high superhero identification pretending to be superheroes tended to take the most risks. Conclusions Given the popularity of superhero media and the present results suggesting superhero identification may relate to injury-risk situations during play, prevention efforts should consider ways to reduce young children’s exposure to superheroes and/or mitigate injury risk during active pretend play.