Playground Safety and Quality in Chicago

WHAT’S KNOWN ON THIS SUBJECT: Quality urban playgroundsthat are accessible and safe support physical activity anddecrease injury rates. Little is known about the quality andaccessibility of playgrounds in Chicago public parks.

WHAT THIS STUDY ADDS: Most playgrounds in Chicago are in faircondition, yet access to quality playgrounds varies byneighborhood. Public/private collaboration can lead to improvedplaygrounds, and failing playgrounds can be improved withmodest investment.

abstractOBJECTIVES: To assess playground safety and quality in Chicago, Illinois,identify disparities in access, and use the data to inform collaborativeimprovement.

METHODS: A cross-sectional survey of public park playgrounds in Chicago,Illinois, was conducted in 2009, 2010, and 2011 by using the NationalProgram for Playground Safety Standardized Survey. All playgroundswere surveyed in 2009 and 2010; those that failed in 2010 wereresurveyed in 2011. Playgrounds were assessed in 4 main categories:age-appropriate design, fall surfacing, equipment maintenance, andphysical environment. Safety scores were generated from theassessment. Geographic information system mapping provided a visualdescription of the playground pass/fail rate based on neighborhood,child population, race/ethnicity, and poverty level.

RESULTS: Of the ∼500 playgrounds, 467 were assessed in 2009, and 459were assessed in 2010. In 2009, half of all playgrounds (55%) and in2010, nearly two-thirds (61%) earned scores consistent with safeplaygrounds (P , .001). Playgrounds scored poorest in fall surfacingand equipment maintenance. Geographic information system mappingshowed neighborhoods with a higher percentage of children andimpoverished families had fewer playgrounds and more failingplaygrounds. In 2011, 154 (85%) of the playgrounds that failed in2010 were surveyed. The mean playground score among failingplaygrounds improved significantly between 2010 (61%) and 2011(67%, P , .001).

CONCLUSIONS: Since the playground improvement initiative began in2009, considerable progress has been made in the safety scores, al-though access to high-quality playgrounds varies by neighborhood.Many failing playgrounds can be brought up to standard withimprovement in fall surfacing and equipment maintenance. Pediatrics2013;131:233–241

AUTHORS: Erin M. Allen, MD,a Amy L. Hill, MS,b ErmaTranter,c and Karen M. Sheehan, MD, MPHb

aDivision of Academic General Pediatrics, Department ofPediatrics, Baylor College of Medicine, Houston, Texas; bInjuryPrevention and Research Center, Ann and Robert H. LurieChildren’s Hospital of Chicago, Chicago, Illinois; and cFriends ofthe Parks, Chicago, Illinois

KEY WORDSplayground injury, playground equipment, physical activity,recreation, injury prevention and control

ABBREVIATIONGIS—geographic information system

Drs Allen, Sheehan and Ms Hill contributed to the conceptionand design, acquisition of data, analysis and interpretation ofthe data, and drafting and revising the article; Ms Trantercontributed to the conception and design and revising thearticle; and all authors provided final approval for submissionof the article.

www.pediatrics.org/cgi/doi/10.1542/peds.2012-0643

doi:10.1542/peds.2012-0643

Accepted for publication Oct 5, 2012

Address correspondence to Erin M. Allen, MD, Baylor College ofMedicine, 3925 Fairmont Parkway, Pasadena, TX 77504. E-mail:emallen@bcm.edu

PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).

Copyright © 2013 by the American Academy of Pediatrics

FINANCIAL DISCLOSURE: The authors have indicated they haveno financial relationships relevant to this article to disclose.

FUNDING: This project was supported by the Kohl’s Cares forKids Safety Network. The Community-Engaged Research CenterGeospatial Analysis Mini-Grant provided funding for geographicinformation system mapping.

COMPANION PAPER: A companion to this article can be found onpage 338, and online at www.pediatrics.org/cgi/doi/10.1542/peds.2012-3371.

PEDIATRICS Volume 131, Number 2, February 2013 233

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Play is central to the healthy growthanddevelopment of children.1,2 Physicalplay, in particular, is associated witha decreased risk of obesity, improvedself-esteem, and improved academicperformance.3–6 Playgrounds can playan important role in supporting phys-ical activity and maintaining a healthyBMI in children, especially in denseurban environments like Chicago.7–10

The quality and accessibility of play-grounds influence both their safety anduse.9–15 Children are more likely to playon recently renovated playgrounds andplaygrounds located near their homes.Poorly maintained playgrounds are lesslikely to engage children and have beenshown to contribute to higher injuryrates.16 Injuries sustained on play-grounds are common, leading to.200000 emergency department visits an-nually.17 Many of these injuries are se-vere, including fractures, dislocations,and concussions.17–21 Improvement inplayground quality may be an effectivestrategy to prevent these injuries.

Concern about playground quality andsafety in Chicago, Illinois motivated lo-cal park advisory council members torequest inspections from A.L.H., a cer-tified playground inspector, to docu-ment safety hazards that could then beused by the Chicago Park District tomake repairs or to build a replacementplayground. This initiative led to theChicago Playground Project, a collabo-rative effort of the Injury Preventionand Research Center at Ann and RobertH. Lurie Children’s Hospital of Chicago,the Chicago Park District, and Friendsof the Parks, a nonprofit park advocacyorganization. The objectives of the pro-ject are to improve the safety of ChicagoPark District playgrounds by (1) buildingpartnerships to promote safe playenvironments, (2) creating a surveil-lance system to monitor the safety of allpark district playgrounds, (3) identifyingplaygrounds in greatest need of im-provement and areas of neighborhood

disparity, and (4) developing system-wide policies to improve playgroundsafety through maintenance and newdevelopment. In this article, we presentthe results of our most recent play-ground surveillance. The aims of thisanalysis were to assess playgroundsafety scores over multiple years and toidentify any areas of disparity in play-ground access and quality. We hypothe-size that by identifying the areas most inneed of improvement, and sharing thisinformation with stakeholders, play-ground scores will improve betweenstudy years.

METHODS

Setting

Chicago has ∼500 public park play-grounds throughout the city. In thisanalysis, we define playgrounds asequipment or structures intended forchildren’s play.22 The Chicago ParkDistrict is responsible for the mainte-nance of these facilities. Many of theplaygrounds were constructed from1988 to 1993 when all of the asphaltplaygrounds were converted intoenclosed loose-fill, soft-surface areas.Between 2004 and 2012, 45 new play-grounds were constructed.

Survey Items and Assessment

The survey was adopted from the Na-tional Program for Playground SafetyStandardized Survey, a standardizedsurvey developed by investigators atthe National Program for PlaygroundSafety at the University of NorthernIowa.23 The survey includes 21 items toassess playground safety related toage-appropriate design, fall surfacing,equipment maintenance, and the sur-rounding physical environment. Itemsare given 1 or 2 points for meeting thestandard. Twelve items are weighted toreceive 2 points because they have thepotential for a significant increase inlife-threatening injury (Table 1).

Three trained surveyors assessed thesafety of all Chicago Park Districtplaygrounds in 2009 and 2010. Play-grounds undergoing constructionwereexcluded from the study. In 2011, sur-veyors assessed only playgrounds thathad earned failing scores in 2010.Surveys were completed during May toOctober each year. Surveyors weretrained by a playground safety in-spector certified by the National Play-ground Safety Institute of the NationalRecreation and Park Association. Eachhad at least 1 year of experience sur-veying park safety. A sample of theirsurveys was verified by the certifiedplayground safety inspector. In 2010and 2011, surveyors collected datausing Android telephones, allowingthem to immediately forward picturesof severely hazardous equipment to theChicago Park District for repair.

To assess age-appropriate design, sur-veyors visually inspected playgroundsfor separate play areas for ages 2 to 5years and 5 to 12 years based on thedesign and scale of the equipment. Theyalso assessed that platforms had ap-propriate guardrails and allowed forchanges of direction when entering andexiting the structure. To assess fallsurfacing, surveyors assessed if ap-propriate surfacing, definedasaunitarysurface made from rubber or otherenergy-absorbing materials or loose-fillwood chips of an appropriate depthwaspresent, if the height of the equipmentwas less than 8 feet, if suitable surfacingwas present within 6 feet of any piece ofplayground equipment, if concrete ba-ses to the playground structure werecovered by surfacing, and if the surfacewas free of foreignobjects, suchas litterand glass.22 They also determined thedepth of loose-fill surfacing by digginga hole to the dirt, concrete, or mattingand measuring from the top to thebottom point of loose fill. Surveyorsmeasured loose-fill surfacing underhorizontal ladders (monkey bars), belt

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swings, and slides and recorded an av-erage of the loose-fill depth. To assessappropriate equipment maintenance,surveyors inspected for broken andmissing parts, protruding bolts andnails, rust, peeling paint, splinters,cracks, and holes in the equipment. Theymanually shook the equipment to en-sure that it was well anchored.24 Theyinspected the equipment for properlyclosed S-hooks and head entrapments. Ahead entrapment is defined as any con-dition that impedeswithdrawal of a bodyor body part that has penetrated anopening and is measured with industry-standard probes. Openings present anentrapment hazard if the distance be-tween any interior opposing surfaces is.3.5 inches and ,9 inches.22 The sur-rounding physical environment wasassessed for well-trimmed tree limbslocated away from equipment, trippinghazards, and proper fencing surround-ing the playground from street traffic.

Geographic Information SystemMapping

Geographic information system (GIS)mapping was completed to providea visual description of the playgroundpass/fail rate. By using the AmericanCommunitySurveypopulationestimatesfrom2005 to 2009,mapswere created toassess thenumberofpassingand failingplaygrounds based on (1) communityarea, (2) percent child population, (3)race and ethnicity, and (4) povertylevel.25 Chicago is divided into 77 well-defined and static community areasthat are tied to census data and serveas the basis for urban planning ini-tiatives.26

Data Analysis

We calculated safety scores as a per-centage of the items that were in ac-cordance with rating standards. Basedon theNational ProgramforPlayground

Safety scoring system, scores $70%indicate a safe playground that re-quires only small improvements.23

Scores #69% indicate a failing play-ground that is potentially hazardousand may require multiple improve-ments. Statistical analyses were com-pleted by using SPSS, version 12 (IBMSPSS Statistics, IBM Corporation,Armonk, NY). Descriptive analysis ofthe playground safety scores was per-formed. For playground survey years2009 and 2010, categorical variables(pass/fail) were compared using x2

tests. Paired t-tests were used tocompare 2009 and 2010 mean play-ground safety scores. In 2011, datacollection was limited to playgroundsthat failed the safety survey in 2010;these 2 years were also compared bypaired t-test. GIS mapping, using USCensus 2000 data and GeoLytics 2007demographic estimates (www.geolytics.com), provided a visual depiction of thedistribution of safe playgrounds in re-lation to race, ethnicity, and income.

RESULTS

Survey of Playgrounds in 2009 and2010

In 2009 and 2010, surveyors collecteddata on 467 and 459 of the ∼500 play-grounds in Chicago; 418 of the play-grounds were assessed both years.Surveyors did not assess playgroundsundergoing construction, ∼20 play-grounds each year, and missed a smallpercentage of playgrounds each year.In 2009, 54% of playgrounds (256/467)earned passing scores, increasing to61% (278/459) in 2010 (x2, P, .001). In2009, themean score was 72%;median,71% (range: 29% to 100%). In 2010, themean score was 73%; median, 72%(range: 45% to 100%) (paired t-test, P =.76). Of the safety domains that wereevaluated (Table 1), most playgroundsmet safety standards in the age-appropriate design and physical envi-ronment categories each year. In both

TABLE 1 Playground Safety Score Items and Percentage of Playgrounds Meeting Safety Standard

Safety Item Assessed Playgrounds Meeting SafetyStandard, %

2009 2010

Age-appropriate designSeparate areas for ages 2–5 and 5–12a 25 26Appropriate guardrails on platforms a 94 91Platforms allow change of directions 97 98

Fall surfacingSuitable surfacing materials are provideda 74 75Height of equipment is ,8 feet a 95 97Appropriate depth of loose fill provideda,b 17 1Six-foot use zone has appropriate surfacinga 97 99Concrete footings are covered by surfacinga 96 95Surface is free of foreign objects 67 84

Equipment maintenanceFree of head entrapmentsa 56 48Free of broken partsa 67 72Free of missing partsa 75 78Well-anchored and stablea 73 58Free of protruding bolts and nailsa 86 81Free of rust and peeling paint 29 38Free of splinters 59 34Free of cracks/holes in plastic equipment 84 86S-hooks are properly closed 28 46

Physical environmentTree limbs are trimmed 97 98No tripping hazards 92 91Playground is properly fenced 99 97

a Denotes items worth 2 points because of potential for significant increase in life-threatening injury.b Approximately 20% of playgrounds have rubber surfacing and are not reflected in this number.

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years, playgrounds scored poorest infall surfacing and equipment mainte-nance. Nearly 25% of playgrounds inboth 2009 and 2010 did not providesuitable surfacing. Suitable playgroundsurfaces include a unitary surfacemade from rubber or other energy-absorbing materials or loose-fill woodchips of an appropriate depth. TheHandbook for Public Playground Safety,issued by the Consumer Product SafetyCommission, recommends a minimumwood chip depth of 9 inches; however,a wood chip depth of 12 inches is ideal.22

The average wood chip depth was 5.9inches in 2009 and 4.0 inches in 2010. Ofplaygrounds with wood chips, 83% in2009 and 99% in 2010 had inadequatesurfacing depth. Playgrounds with rub-ber surfacing were less likely to fail inboth years than playgrounds with woodchips (P, .001). Approximately, 20% ofplaygrounds each year had rubbersurfacing.

Playgrounds scored poorly in severalareas of equipment maintenance. Ofthe items with potential to causelife-threatening injury, nearly equal

percentage of playgrounds in 2009 and2010 had head entrapments, brokenparts, andmissingparts. Thenumberofplaygrounds with equipment that waspoorly anchored and unstable in-creased from 27% in 2009 to 42% in2010.

Survey of Playgrounds in 2011

Of the 181 playgrounds that earnedfailing scores (#69%) in 2010, 154(85%) were reassessed in 2011. Uponreassessment, 40% (62/154) earnedpassing scores. Mean scores of that

FIGURE 1Map depicting passing and failing playgrounds in relation to percentage of children 14 years old and younger.

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sample increased from 61% in 2010 to67% in 2011 (paired t-test, P , .001).

GIS Mapping

GIS mapping revealed that passing play-grounds and failing playgrounds weredistributed across the city of Chicago;however, noticeable and importantneighborhood differences exist. Neigh-borhoods where more children live havemore failing playgrounds and notablyfewer playgrounds (Fig 1). Similarly,neighborhoods where a larger per-centage of the population is below

the poverty level have more failingplaygrounds and fewer playgrounds(Fig 2). Neighborhoods with a higherpercentage of African American chil-drenhadmore failingplaygrounds (Fig 3),and areas with higher percentage ofHispanic children had fewer play-grounds (Fig 4).

DISCUSSION

Safe and accessible playgrounds play animportant role in supporting healthygrowth and development in children. Inthis study, we report on the safety of

playgrounds in Chicago from 2009 to2011. Our results show that most play-grounds are in fair condition althoughthere is a disparity in geographicaldistribution of both playgrounds andsafe playgrounds. Playgrounds system-atically met safety standards for theage-appropriate design and physicalenvironment criteria. They were morelikely to failbecauseofproblemswith fallsurfacing and equipment maintenance.One-quarter of playgrounds did notprovide adequate surfacing, and mostplaygrounds with wood chip surfacingdid not provide an adequate depth of

FIGURE 2Map depicting passing and failing playgrounds in relation to percentage of the population below the poverty level.

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wood chips. The lack of adequate sur-facing is particularly important, as fallsto the surface account for up to 75% ofinjuries on playgrounds.17 Use of safesurfacing can reduce the severity andprevalence of these injuries.27–29 Addi-tionally, playgrounds did not meet sev-eral equipment maintenance safetystandards.

We are using the information from ourplayground surveillance study to im-prove playground safety by providinglocal, timely, accurate, accessible, andeasily understood data for our collab-oration with the Chicago Park Districtand Friends of the Parks. Thus far, our

efforts have been focused on improvedmaintenanceand increasedcommunityawareness. For example, when oursurveyors note a playground hazardthat has risk to cause substantial harm,a photo of the hazard and its location issent to the park district so a mainte-nance crew can be dispatched to repairor remove the hazard. In addition toprovidingprompt notification for timelyrepair of significant hazards during oursurveys,wehavesupported theChicagoPark District by providing continuingeducation funds for select employees tobe trained as certified outdoor playinspectors. We will also be providing

generalplaygroundsafety training toallmaintenance staff. Additionally, on theFriends of the Parks Web site, we postthe safety score of each playground toinform the community of their localplayground’s status. Community mem-bers have used this information toadvocate for playground improve-ments or replacement.

During our 3-year study period, con-siderable progress has been made inthe safety scores. More playgroundsreceived passing scores between 2009and2010. This trendcontinuedwith40%of theplaygroundssampled fromfailing2010 playgrounds moving into the

FIGURE 3Map depicting passing and failing playgrounds in relation to percentage of the black population.

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passing range in 2011. Continuing tomakesimple, cost-effective interventions,such as systematically replacing woodchips, repairing broken equipment, andremoving unsafe equipment, could sig-nificantly improve the scores and safetyof the playgrounds going forward.

GISmappingvisually revealeddisparitiesbetweenneighborhoods.Neighborhoodswith a higher percentage of children,especiallyminoritychildren,andahigherpercentage of the population living inpoverty had both fewer playgroundsand more failing playgrounds. Pre-vious studies have shown similar re-sults. A study in Boston found that

neighborhoods with a greater propor-tion of youth living in poverty had lessaccess to playgrounds, especially safeplaygrounds.30 Similarly, a national studyfound that areas with lower medianincomes had less access to a wide vari-ety of public and private facilities forphysical activity, including categories offacilities that were expected to bedistributed equally (eg, playgrounds,YMCAs, and schools).31 A smallerstudy evaluating the safety of Chicagoplaygrounds in low-income and very low-income neighborhoods found the play-grounds to be of overall good design butneeding improvement in wood chip

depth and equipment repairs.32 Lack ofaccess to safe playgrounds may beparticularly important for children livingin neighborhoods with few playgroundsbecause theymay bemore dependent onpublic playgrounds for outdoor play.

Our study has several limitations. Al-though it would seem to be a simpletask, it is a challenge to count theprecise number of playgrounds in theChicago Park District because manyparks have multiple playground struc-tures, some separated by a few yards,others by a few blocks. Nevertheless,each year that we did a full assessmentwe believe we have surveyed at least

FIGURE 4Map depicting passing and failing playgrounds in relation to percentage of the Hispanic population.

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90% to 95% of eligible playgrounds.Additionally, our study only evaluatedplaygrounds located in public parksand did not evaluate other frequentlyused playgrounds, such as those lo-cated at schools or day care sites.Moreover,ourstudy is limited toasinglelarge Midwestern city, which may limitthegeneralizabilityof theprojectaswellas the results.

Althoughwe used a standard survey tooltoassesstheplaygrounds, ithasnotbeenvalidated. Only one study to date hasattempted validation and revealed highreliability (Cronbach’s a = 0.963, intra-class correlation coefficient = 0.926)between 2 different measures con-ducted by the same trained surveyor.33

Determining the depth of wood chips, inparticular, is inherently difficult andinfluenced by when the measurementis taken in relation to routine re-plenishment of the chips. It is possible

that our measurements varied betweenstudy years because of the timing of ourassessment relative to wood chip re-placement. The survey tool defines$70% as passing, but we do not knowhow well this score discriminates therisk of injury. In other words, a play-ground with a score of 68% may inpractice not be different from a play-ground with a score of 72%. The use-fulness of the survey tool may not be inits absolute score but that it consis-tently measures change over time. Byidentifying playgrounds most in need ofimprovement and criteria that lead topoor playground safety scores, in-formed choices can be made in de-veloping systemwide policies forplayground maintenance.

CONCLUSIONS

In summary, playground safety scoresvaried across the city of Chicago.

Playgrounds were more likely to failbecause of problemswith fall surfacingand equipment maintenance. Addi-tionally, neighborhoods with morechildren, especially minority children,and impoverished families had fewerplaygrounds and more failing play-grounds. However, steady improve-ments were made during our studyperiod. By strengthening our commu-nity partnerships, we hope to developsafe neighborhood playgrounds thatare equitably distributed to benefit thehealth of children and their communi-ties.

ACKNOWLEDGMENTSWe gratefully acknowledge the Chi-cago Park District for their involvementin this project and Albert Benedictand the Center for Neighborhood Tech-nology for completing the GIS map-ping.

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BLUE: The other day, I went online to updatemy professional medical information.After creating an account and a unique 10-character password, I was thenprompted to select three questions to which, presumably, only I would know theanswer. The very first question was: “What is your favorite color?” Whoeverdesigned that question clearly did not know much about human color prefer-ences. As reported in The New York Times (Science: November 22, 2012), humanshave a distinct fondness for the color blue. Inmost cultures, approximately 50% ofpeople report their favorite color is blue. Although only one in six Americans haveblue eyes, half the population thinks that blue eyes are the prettiest. Throughouthuman history, blue coloring has been highly valued and implied nobility, value,and social standing. Blue pigments were often more valuable than gold. Whilemany psychologists believe that the color blue suggests calmness and open-endedness, blue can convey depression as well. Pablo Picasso, depressed by thesuicide of a friend, for years painted in shades of blue. People still refer todysthymia and feeling down as “the blues.” Scientists are intrigued by the colorprimarily because of its intensity and rarity among land animals. Researchersrecently described the structural analysis of a remarkably and intensely bluefruit from the African Pollia condensata plant. Other scientists reported thediscovery in the Congo basin of a rare new species of monkey with a patch of vividblue skin – a startling contrast to the browns, tans, and blacks found in mostother mammalian species. To be honest, I too like blue. I thought about writingchartreuse asmy favorite color at the login prompt, but realized I would probablyforget, and had to stick with blue.

Noted by WVR, MD

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