Developing non-response weights to account for attrition-related bias in a longitudinal pregnancy cohort.

BACKGROUND: Prospective cohorts may be vulnerable to bias due to attrition. Inverse probability weights have been proposed as a method to help mitigate this bias. The current study used the "All Our Families" longitudinal pregnancy cohort of 3351 maternal-infant pairs and aimed to develop inverse probability weights using logistic regression models to predict study continuation versus drop-out from baseline to the three-year data collection wave. METHODS: Two methods of variable selection took place. One method was a knowledge-based a priori variable selection approach, while the second used Least Absolute Shrinkage and Selection Operator (LASSO). The ability of each model to predict continuing participation through discrimination and calibration for both approaches were evaluated by examining area under the receiver operating curve (AUROC) and calibration plots, respectively. Stabilized inverse probability weights were generated using predicted probabilities. Weight performance was assessed using standardized differences of baseline characteristics for those who continue in study and those that do not, with and without weights (unadjusted estimates). RESULTS: The a priori and LASSO variable selection method prediction models had good and fair discrimination with AUROC of 0.69 (95% Confidence Interval [CI]: 0.67-0.71) and 0.73 (95% CI: 0.71-0.75), respectively. Calibration plots and non-significant Hosmer-Lemeshow Goodness of Fit Tests indicated that both the a priori (p = 0.329) and LASSO model (p = 0.242) were well-calibrated. Unweighted results indicated large (> 10%) standardized differences in 15 demographic variables (range: 11 - 29%), when comparing those who continued in the study with those that did not. Weights derived from the a priori and LASSO models reduced standardized differences relative to unadjusted estimates, with the largest differences of 13% and 5%, respectively. Additionally, when applying the same LASSO variable selection method to develop weights in future data collection waves, standardized differences remained below 10% for each demographic variable. CONCLUSION: The LASSO variable selection approach produced robust weights that addressed non-response bias more than the knowledge-driven approach. These weights can be applied to analyses across multiple longitudinal waves of data collection to reduce bias.

You exhaust me! Air pollution exposure near schools during pick-up and drop-off times.

Background: Public and healthcare practitioner awareness of climate change and the longitudinal health impacts of air pollution is growing; however, it is not always clear how to implement practical and feasible steps that individuals and communities can take to help decrease air pollution and protect children, and it can be challenging to request and enforce behaviour changes that the public associates with perceived personal inconvenience. In this context, it is important to consider common, chronic exposures that increase children's risks, especially when straightforward solutions with minimal negative impact where significant evidence-based positive results are available. Aims: This article provides simple tips that healthcare providers, parents, and communities can use to advocate for decreased idling in school zones to improve air quality in and around schools.

Oxidative stress and DNA damage resulting from welding fumes exposure among professional welders: A systematic review and meta-analysis.

The present systematic review aimed to evaluate the associations between welding fumes exposure and changes in oxidative stress [superoxide dismutase (SOD) and malondialdehyde (MDA)] and DNA damage [8-hydroxy-2'-deoxyguanosine (8-OHdG) and DNA-protein crosslink (DPC)] markers in professional welders (PROSPERO CRD42022298115). Six electronic bibliographic databases were searched from inception through September 2021 to identify observational epidemiological studies evaluating the association between welding fumes exposures and changes in oxidative stress and DNA damage in professional welders. Two reviewers independently assessed the risk of bias and certainty of the evidence. A narrative synthesis of results was conducted using the Synthesis Without Meta-analysis (SWiM) method. Pooled mean differences with 95% confidence intervals were calculated in a random-effects meta-analysis for the outcomes of interest in the review. From 450 studies identified through the search strategy, 14 observational epidemiological studies were included in the review. Most studies reported significantly higher welding fumes levels in welders than in controls. The narrative synthesis results of SOD showed a significant difference between welders and controls, while the meta-analysis results of MDA did not show a significant difference between the studied groups (MD = 0.26; 95% CI, -0.03, 0.55). The meta-analysis results of 8-OHdG (MD = 9.38; 95% CI, 0.55-18.21) and DPC (MD = 1.07; 95% CI, 0.14-2) revealed significantly differences between the studied groups. The included studies were at high risk of exclusion and confounding bias. The certainty of the evidence for oxidative stress and DNA damage results were very low and moderate, respectively. Exposure to welding fumes and metal particles is associated with DNA damage in professional welders, and 8-OHdG and DPC might be considered reliable markers to assess DNA damage resulting from exposure to welding fumes. We recommend, however, that the evaluation of oxidative stress resulting from welding fumes exposure not be solely based on MDA and SOD.

The effectiveness of booster seat use in motor vehicle collisions.

BACKGROUND: Alberta remains the only province in Canada without booster seat legislation. To date, analyses of booster seat effectiveness compared with seatbelt only use have demonstrated mixed findings using observational data. METHODS: This study uses Alberta police collision report data for the years 2010-2016, inclusive. Using a case-control study design, children aged four to eight years, who were reported by police to be injured (cases), were compared with uninjured controls for restraint use (seatbelt, booster seat or no restraint). Logistic regression was used to estimate the relation between booster seat use and injury with adjusted odds ratios (aORs) and 95% confidence intervals (CI), stratified by collision types. RESULTS: There were 12,922 children involved in collisions, of whom 570 were injured. Approximately 62% of all children included in the analysis were in a booster seat or safety seat at the time of collision. Crude analysis indicates higher odds of injury for seatbelt wearers compared with booster seat use (OR = 1.21; 95% CI: 1.02-1.44). Front-end vehicle-vehicle collisions, demonstrated higher odds of injury for seatbelt wearers relative to those in booster seats (aOR = 1.46; 95% CI: 1.03-2.07). CONCLUSION: This analysis indicates a protective effect of booster seats that varies depending on the type of collision and impact location. These regionally-specific injury data may encourage and inform policy on the use of booster seats. Moreover, stratification by collision type may be necessary to inform analyses on booster seat effectiveness.

Identifying modifiable factors related to novice adolescent driver fault in motor vehicle collisions.

OBJECTIVE: Novice adolescent drivers have a higher propensity to engage in risky driving and are at higher odds of being involved in collisions. Graduated driver licensing programs have been instituted to help novice drivers gain experience while avoiding higher risk driving circumstances. This study examines modifiable risk factors contributing to novice adolescent driver fault in collisions. METHODS: Police traffic collision report data from municipalities in Alberta for the years 2010-2016, inclusive, were used. Fault in collision was assigned using an automated and previously validated tool for assigning culpability. Factors contributing to novice adolescent (16-19 years of age) fault in collision were examined using multivariable logistic regression. RESULTS: Novice adolescent drivers had higher adjusted odds ratios (aOR) of being at-fault in collision when driving from 01:00-05:00 (aOR = 1.38; 95% Confidence Interval [CI]: 1.26-1.50). Novice adolescent drivers had lower odds of fault when driving with an adult (aOR= 0.62; 95% CI: 0.57-0.68) or a single peer (aOR= 0.87; 95% CI: 0.80-0.94), but higher odds of causing a severe collision with a single peer present (aOR= 2.23; 95% CI: 1.21-4.11). Impairment of the teen driver was reported in 25% of all fatal collisions, and 40% of late-night fatal collisions. CONCLUSIONS: The findings support policies that allow driving with a single adult or peer passenger during daytime hours. Driving during late-night hours should be restricted for novice adolescent drivers.

The Relationship of Urban Form on Children and Adolescent Health Outcomes: A Scoping Review of Canadian Evidence.

Urban form can have an impact on health outcomes in children, and the synthesis of findings can identify gaps in the literature and regional reviews may help guide policymakers. This study aims to complete a scoping review of the research relating urban form to health outcomes in children and adolescents from urban Canadian settings. Thirteen online databases were searched to identify studies that had objective measures of urban form and health outcomes. Two research assistants independently reviewed 27,444 titles and abstracts, and 176 full-text articles, returning 32 unique studies with youth-specific data. The majority of the included studies were cross-sectional or ecological (n = 26). Six studies used Canada-wide data and the rest were from Ontario (n = 11), Alberta (n = 6), and Quebec (n = 6). Urban form characteristics included neighbourhood food environment (n = 11), parks/natural space/greenness (n = 10), road or intersection characteristics (n = 7), and aggregated urban form measures (n = 7). Studies examined a variety of health outcomes: the majority considered weight status (n = 16) and injury (n = 10). Although there is over-reliance on mainly cross-sectional study designs, there is evidence suggesting that urban form is associated with health outcomes in Canadian youth, with parks/greenspace, road connectivity, and road characteristics most consistently associated with health outcomes in youth.

Identifying motorist characteristics associated with youth bicycle-motor vehicle collisions.

Objective: The objective of this study was to identify driver characteristics associated with youth bicycle-motor vehicle collisions in Alberta, Canada. Methods: Edmonton and Calgary police collision report data from the years 2010-2014 were used. From these data, motor vehicle collisions involving youth (<18 years old) were identified (cases). The controls were drivers who, over the same period, were involved in separate motor vehicle-only collisions but deemed not at fault using an automated culpability analysis. Control selection used the quasi-induced exposure method, assuming that not-at-fault drivers in collisions are representative of the typical driver (source population). Descriptive statistics, including proportions, medians, and interquartile ranges (as appropriate) were used to describe the characteristics of the case and control drivers. Purposeful variable selection techniques were used to inform multivariable logistic regression models and results are presented as adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Results: Four hundred twenty-three drivers involved in youth bicycle-motor vehicle collisions were identified, as were 243,927 not-at-fault control drivers. Drivers >54 years old had higher odds of involvement in youth bicycle-motor vehicle collisions than drivers between 25 and 39 years old (aOR = 1.37; 95% CI, 1.03, 1.82). Compared to driving between 3:01 p.m. and 6:00 p.m., driving between 12:01 a.m. and 6:00 a.m. (aOR = 0.27; 95% CI, 0.11, 0.66), between 6:01 a.m. and 9:00 a.m. (aOR = 0.61; 95% CI, 0.44, 0.85), or between 9:01 a.m. and 12:00 p.m. (aOR = 0.26; 95% CI, 0.16, 0.41) had lower odds of bicyclist collision, whereas driving between 6:01 p.m. and 12:00 a.m. had higher odds (aOR = 1.34; 95% CI, 1.01, 1.79). Driving a truck/van had lower odds of bicyclist collision compared to driving a passenger car (aOR = 0.67; 95% CI, 0.48, 0.94). Conclusions: Culpability analysis is typically applied to motorists to identify transient exposures; however, this study used culpability analysis to select control drivers who could be compared with drivers involved in youth bicycle-motor vehicle collisions. This study highlights motorist characteristics in youth bicycle-motor vehicle collisions. In doing so, we hope to inform primary prevention strategies for motorists and the environment that will reduce collisions.

Child and adolescent bicycling injuries involving motor vehicle collisions.

BACKGROUND: Bicycle-related injuries are among the most common recreational injuries for children in Canada; moreover, bicycle-motor vehicle collisions often result in serious injuries. This study seeks to examine environmental, motorist, and bicyclist characteristics of bicycle-motor vehicle collisions that resulted in police reported severe injuries in youth (< 18 years old) bicyclists, in Alberta, Canada. FINDINGS: Using Calgary and Edmonton police collision reports, 423 youth bicycle-motor vehicle collisions were identified from 2010 to 2014. Forty-three (10.2%) of these collisions resulted in major/fatal (severe) injuries. These severe injury cases were compared with the 380 youth bicycle-motor vehicle collisions resulting in minor or no injury (controls) using classification tree and logistic regression analyses. There were no driver or bicyclist characteristics with a significant effect on the odds of severe injury to youth bicyclists; however, lower odds were found on each of: divided roads with no barrier (aOR = 0.36; 95% CI: 0.13-0.97) or during peak traffic time (aOR = 0.44; 95% CI: 0.16-0.99). CONCLUSION: Personal and environment characteristics should be considered in future research and interventions focused on reducing severe youth bicycle-motor vehicle collision injuries.

Adaptation of a Canadian culpability scoring tool to Alberta police traffic collision report data.

Objective: The objective of this study was to adapt a previously validated Canadian Culpability Scoring Tool (CCST) to Alberta police report data. Methods: Police traffic collision reports from motor vehicle (MV) collisions in Calgary and Edmonton (Alberta, Canada) from 2010 to 2014 were used. Adaptation of the CCST was completed with input from personnel within Alberta Transportation, contributing to face and content validity. Two research assistants, given only the information necessary for scoring, evaluated 175 randomly selected MV-MV collisions. Interrater agreement was estimated using kappa (k) and reported with 95% confidence intervals (CIs). Discussion of disagreements between the research assistants and consultation from Alberta Transportation informed the algorithm used in the Alberta Motor Vehicle Collision Culpability Tool (AMVCCT). The AMVCCT was automated and applied to all motorists involved in collisions. Binary logistic regression was used to examine characteristics of the culpable and nonculpable drivers and their effects were reported using odds ratios (ORs) with 95% CIs. Results: Interrater agreement for the random sample was excellent (k = 0.95; 95% CI, 0.92-0.99). Of those drivers hospitalized, 1,130 (37.54%) were rated not culpable and 1,880 (62.46%) were rated culpable. The odds of being culpable were higher for males than for females (OR = 1.43; 95% CI, 1.23-1.66). The odds of being culpable were higher in those impaired by alcohol than those considered "apparently normal" (OR = 61.10; 95% CI, 22.66-164.75). The odds of being deemed culpable, when compared with drivers >54 years old, were higher for those <25 years old (OR = 1.72; 95% CI, 1.35-2.20) and lower for those in the 40- to 54-year-old age group (OR = 0.78; 95% CI, 0.63-0.96). Driving between 12 a.m. and 6 a.m. resulted in higher odds of being culpable compare with all other 6-h time blocks. Direction and statistical significance remained consistent when applying the tool to all MV collisions. Sensitivity analysis including the removal of single vehicle collisions did not affect the direction or statistical significance of the main results. Conclusions: The AMVCCT identified a culpable group that exhibited characteristics expected in drivers who are at fault in collisions. The age groups 25-39 and 40-54 demonstrated different results than the CCST. However, this is the only difference that exists in the findings of the AMVCCT compared to the CCST and could exist due to differences between the driving populations in Alberta and British Columbia. It is possible to adapt the CCST to provinces outside British Columbia and, in doing so, we can identify risk factors for collision contribution and not-at-fault drivers who represent the driving population.