Environmental influences on E-cigarette use among young people: A systematic review.

E-cigarettes are a popular mode of delivery for nicotine, tobacco and cannabis. The prevalence of vaping among youth is increasing and this review aims to identify features of the neighbourhood environment, e.g., retailers, advertisements, and policies, that are associated with youth vaping. We included 48 studies. Of these, approximately 40% and 60% reported that presence of e-cigarette retailers, and advertisements, was associated with statistically higher odds of e-cigarette use in youth, respectively. Approximately 30% of studies reported that policies affecting e-cigarette availability were associated with statistically lower odds of vaping. Identifying these influential features of the neighbourhood environment will help formulate appropriate policies to reduce e-cigarette use among youth.

Residential greenness and substance use among youth and young adults: Associations with alcohol, tobacco, and marijuana use.

INTRODUCTION: Research has identified positive associations between green space and physical and mental health outcomes. Substance use outcomes, however, have received considerably less attention. This study investigates the association between residential greenness and substance use through an analysis of alcohol, tobacco, and marijuana use among youth and young adults. METHODS: This study utilized three waves (2016-2018) of the Canadian Community Health Survey (CCHS), as well as residential greenness data from the Canadian Urban Environmental Health Consortium (CANUE). Multinomial logistic regression was used to explore variation in the pattern of substance use between greenness quartiles. The sample included 14,070 youth and young adults (15-25 years). RESULTS: Residential greenness was not associated with alcohol use in general but was associated with lower odds of frequent binge drinking. Residential greenness was also associated with lower odds of tobacco use and greater odds of marijuana use. CONCLUSION: This study provides evidence that residential greenness is associated with patterns of substance use. The strength and direction of association, however, is highly contingent upon the substance under investigation. Living in greener neighborhoods may confer certain benefits to substance use and abuse among youth and young adults.

Correlates of Lifetime and Past Month Vape Use in a Sample of Canadian University Students.

INTRODUCTION: This study examines correlates of lifetime (ie, ever vaped) and past month vape use among students aged 17 to 19 years, 20 to 25 years, and 26+ years from Western University in London, Ontario. The secondary objective is to assess lifetime and past month vape use among students not of legal age to purchase vaping products in Ontario (ie, those 17 to 18 years only). METHODS: Using Qualtrics, a cross-sectional survey was sent via email to all students at Western University (N = 38 442), assessing their current and past risk-taking behaviors, mental health, sociodemographic characteristics, as well as questions pertaining to their family structure and socioeconomic background during childhood. Students were asked if they had ever vaped in their lifetime and about past month vape use. Logistic regression models were used to assess correlates of lifetime and past month vape use. RESULTS: The sample consisted of 2626 university students. Compared to those ages 26+ years, teenage university students were 10 times more likely to have vaped in the past month and males were twice as likely as females to have vaped. Alcohol use doubled the odds of vaping in the past month, whereas cigarette, cannabis, or cocaine use approximately tripled the odds. Students who reported many sexual partners were far more likely to have vaped in the past month. CONCLUSION: Vape use is more common among teenage university students, males, those who drink alcohol, smoke, use cannabis or cocaine, and who report many sexual partners.

Examining how changes in provincial policy on vape marketing impacted the distribution of vaping advertisements near secondary schools in London, Ontario.

OBJECTIVES: On January 1, 2020, the Government of Ontario passed a regulation banning vaping advertisements by retailers, apart from specialty shops. A motivation for this ban was to limit youth exposure to vaping advertisements. The primary goal of this research was to evaluate the impact of this ban on the number and density of vaping advertisements surrounding secondary schools. Additionally, we examined whether the number of vaping advertisements varied by school socio-demographic characteristics. METHODS: This study used a pre-post design. Audits were conducted December 2019 (pre-ban) and again January to February 2020 (post-ban), to identify vaping advertisements within 800 m surrounding secondary schools (n = 18) in London, Ontario. RESULTS: Prior to the ban, there were 266 vaping advertisements within 800 m of secondary schools. After the ban, this was reduced to 58, a 78.2% reduction. The mean number of vaping advertisements surrounding schools significantly decreased from 18.1 before the ban to 3.6 after the ban (p < 0.001). A significant positive correlation was found, prior to the ban, between the number of vaping advertisements surrounding schools and school-level residential instability (r = 0.42, p = 0.02). After the ban, no significant correlations were found between the number of vaping advertisements and school socio-demographic characteristics. CONCLUSION: The provincial ban of vaping advertisements in select retail settings significantly reduced the number of vaping advertisements in the areas surrounding secondary schools in London, Ontario. The ban also reduced socio-demographic inequities in youths' potential exposure to marketing of vaping products. Continued monitoring of the geographic accessibility and promotion of vaping products is warranted.

RéSUMé: OBJECTIFS: Le 1er janvier 2020, le gouvernement de l'Ontario adoptait un règlement interdisant les annonces publicitaires sur le vapotage dans les magasins de détail, sauf dans les boutiques spécialisées. L'une des raisons de cette interdiction était de limiter l'exposition des jeunes à la publicité sur le vapotage. Notre étude visait principalement à évaluer les incidences de l'interdiction sur le nombre et la densité des annonces publicitaires sur le vapotage autour des écoles secondaires. Nous avons aussi cherché à déterminer si le nombre d'annonces publicitaires sur le vapotage variait selon le profil sociodémographique des écoles. MéTHODE: Un protocole avant-après été utilisé pour cette étude. Des audits ont été menés en décembre 2019 (avant l'interdiction), puis de nouveau en janvier et février 2020 (après l'interdiction) pour dénombrer les annonces publicitaires sur le vapotage dans un rayon de 800 m des écoles secondaires (n = 18) de London, en Ontario. RéSULTATS: Avant l'interdiction, il y avait 266 annonces publicitaires sur le vapotage dans un rayon de 800 m des écoles secondaires. Après l'interdiction, ce nombre n'était plus que de 58, soit une baisse de 78,2 %. Le nombre moyen d'annonces publicitaires sur le vapotage autour des écoles a diminué de façon significative, passant de 18,1 avant l'interdiction à 3,6 après (p < 0,001). Une corrélation positive significative a été observée, avant l'interdiction, entre le nombre d'annonces publicitaires sur le vapotage autour des écoles et l'instabilité résidentielle au niveau des écoles (r = 0,42, p = 0,02). Après l'interdiction, aucune corrélation significative n'a été observée entre le nombre d'annonces publicitaires sur le vapotage et le profil sociodémographique des écoles. CONCLUSIONS: L'interdiction provinciale des annonces publicitaires sur le vapotage dans certains magasins de détail a considérablement réduit le nombre de ces annonces dans les environs des écoles secondaires de London, en Ontario. L'interdiction a aussi réduit les iniquités sociodémographiques de l'exposition potentielle des jeunes au marketing des produits de vapotage. Il est justifié d'assurer une surveillance continue de l'accessibilité géographique et de la promotion des produits de vapotage.

Evaluation of a population health strategy to reduce distracted driving: Examining all "Es" of injury prevention.

BACKGROUND: Cell phone use while driving (CPWD) increases the risk of crashing and is a major contributor to injuries and deaths. The objective of this study was to describe the evaluation of a multifaceted, evidence-based population health strategy for the reduction of distracted driving. METHODS: A multipronged campaign was undertaken from 2014 to 2016 for 16- to 44-year-olds, based on epidemiology, focused on personal stories and consequences, using the "Es" of injury prevention (epidemiology, education, environment, enforcement, and evaluation). Education consisted of distracted driving videos, informational cards, a social media AdTube campaign, and a movie theater trailer, which were evaluated with a questionnaire regarding CPWD attitudes, opinions, and behaviors. Spatial analysis of data within a geographic information system was used to target advertisements. A random sample telephone survey evaluated public awareness of the campaign. Increased CPWD enforcement was undertaken by police services and evaluated by ARIMA time series modeling. RESULTS: The AdTube campaign had a view rate of >10% (41,101 views), slightly higher for females. The top performing age group was 18- to 24-year-olds (49%). Our survey found 61% of respondents used handheld CPWD (14% all of the time) with 80% reporting our movie trailer made them think twice about future CPWD. A stakeholder survey and spatial analysis targeted our advertisements in areas of close proximity to high schools, universities, near intersections with previous motor vehicle collisions, high traffic volumes, and population density. A telephone survey revealed that 41% of the respondents were aware of our campaign, 17% from our print and movie theater ads and 3% from social media. Police enforcement campaign blitzes resulted in 160 tickets for CPWD. Following campaign implementation, there was a statistically significant mean decrease of 462 distracted driving citations annually (p = 0.001). CONCLUSION: A multifaceted, evidence-based population health strategy using the Es of injury prevention with interdisciplinary collaboration is a comprehensive method to be used for the reduction of distracted driving. LEVEL OF EVIDENCE: Therapeutic, level IV.

Assessing the effectiveness of actionable nutrigenomics and lifestyle genomics interventions for weight management in clinical practice: A critical, scoping review with directions for future research.

BACKGROUND: The use of nutrigenomics and lifestyle genomics in clinical practice has the potential to optimize weight-related outcomes for patients. AIM: A scoping review was conducted to summarize and evaluate the current body of knowledge related to the effectiveness of providing DNA-based lifestyle advice on weight-related outcomes, with the aim of providing direction for future research. METHOD: Primary studies were included if they were written in English, evaluated weight-related and/or body mass index and/or body composition outcomes, and provided participants with an actionable genetic-based lifestyle intervention; interventions that only provided information on genetic risk for diseases/conditions were excluded. Data was extracted from each article meeting inclusion criteria (N=3) and the studies were critically appraised for methodological limitations. RESULTS: Research in this area is promising, but limited. Specific limitations relate to study designs, the nature of the recommendations provided to participants, small (underpowered) sample sizes, the use of self-reported weight/BMI data and lack of consideration of important confounding factors. CONCLUSIONS: Therefore, the effectiveness of nutrigenomics and lifestyle genomics interventions for weight management in clinical practice cannot yet be conclusively determined. Recommendations for future research are detailed in the present manuscript.

Infants' and toddlers' physical activity and sedentary time as measured by accelerometry: a systematic review and meta-analysis.

BACKGROUND: Early experiences in physical activity (PA) are important to shape healthy movement behaviours long-term; as such, it is critical that PA is promoted from infancy, and that detrimental behaviours (e.g., prolonged sedentary time [ST]) are minimized. The purpose of this systematic review and meta-analysis was to examine infants' and toddlers' movement behaviours across daytime hours. METHODS: Seven online databases were searched for terms related to infants (< 12 months), toddlers (12-35.9 months), PA, ST, and accelerometry. Two independent reviewers examined 4873 articles for peer-reviewed original research, published in English, that assessed infants' (counts/min) and/or toddlers' PA or ST (min/day) using accelerometry across daytime hours. Infants' mean PA level (counts/min) was averaged across studies, and ranges were produced. Estimates of toddlers' movement behaviours were aggregated meta-analytically to produce average daily rates, and accelerometer placement, cut-point validity, device type, and epoch length were tested as a moderating variables. RESULTS: Twenty-four studies from 16 countries (published 2011-2019), representing 3699 participants, were included in the systematic review. Five studies reported on infants' PA, which ranged from 78.2 to 2580.5 cpm. Across 20 studies, toddlers' total PA, light PA, moderate-to vigorous-intensity PA, and ST ranged from 72.9 to 636.5, 48.5 to 582.4, 6.5 to 89.9, and 172.7 to 545.0 min/day, respectively. After taking into account accelerometer placement, cut-point validity, device type, and epoch length, we found that toddlers engaged in 246.19 min/day (SE = 28.50; 95% CI: 190.34, 302.04) of total PA, 194.10 min/day (SE = 28.76; 95% CI: 137.73, 250.47) of light PA, and 60.16 min/day (SE = 5.88; 95% CI: 48.64, 71.69) of moderate-to vigorous-intensity PA. Toddlers engaged in 337.04 min/day (SE = 32.67; 95% CI: 273.01, 401.07) of ST. CONCLUSIONS: With limited studies conducted in infants (n = 5), PA estimates are inconclusive and largely heterogeneous. Overall, toddlers tend to exceed the total PA recommendation of 180 min/day; however, very little of this time is spent at higher movement intensities. Even with high PA rates, toddlers still engage in substantial ST. More consistent and valid measurement protocols are needed to improve comparability across studies.

Risk Factors and Birth Outcomes Associated with Teenage Pregnancy: A Canadian Sample.

STUDY OBJECTIVE: To examine the extent to which socioeconomic status, mental health, and substance use are associated with teenage pregnancies in Southwestern Ontario (SWO), and whether these pregnancies are at an elevated risk for adverse birth outcomes, after controlling for medical, behavioral, and socioeconomic status factors. DESIGN: Retrospective cohort study using perinatal and neonatal databases. SETTING: Tertiary care hospital in SWO. PARTICIPANTS: Women residing in SWO who gave birth to singleton infants without congenital anomalies between 2009 and 2014. Teenage pregnancies (19 years of age or younger) were compared with pregnancies of women 20-34 years and 35 years or older. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Low birth weight (LBW), very LBW, term LBW, preterm birth, very preterm birth, low and very low Apgar score, and fetal macrosomia. RESULTS: Of 25,263 pregnant women, 1080 (4.3%) were 19 years of age or younger. Approximately 18% of teenage mothers lived in socioeconomically disadvantaged neighborhoods, compared with 11% of mothers aged 20-34 and 9% of women 35 years of age or older (P < .001). Teenage mothers had higher rates of depression during pregnancy (9.8%) than mothers 20-34 years (5.8%) and those 35 years of age or older (6.8%; P < .001). Young mothers self-reported higher tobacco, marijuana, and alcohol use during pregnancy than adult mothers (P < .001). Teenage pregnancy increased the risk of a low Apgar score (adjusted odds ratio, 1.56; 95% confidence interval, 1.21-2.02), but was not associated with other birth outcomes after adjusting for covariates. CONCLUSION: Teenage pregnancy is associated with a higher risk of socioeconomic disadvantage, mental health problems, and substance use during pregnancy, but is largely unrelated to adverse birth outcomes in SWO.

Study protocol of a pragmatic randomized controlled trial incorporated into the Group Lifestyle Balance™ program: the nutrigenomics, overweight/obesity and weight management trial (the NOW trial).

BACKGROUND: The nutrigenomics, overweight/obesity and weight management trial (NOW Trial) is a pragmatic randomized controlled trial of community-dwelling adults recruited from the Group Lifestyle Balance™ (GLB™) Program. The GLB™ Program (formerly referred to as the Diabetes Prevention Program) is an evidence-based, intensive weight management program, which was offered to overweight/obese patients (BMI ≥ 25.0 kg/m2) in a rural Ontario community. METHODS: Patients enrolled in the GLB™ Program were invited to participate in this study. GLB™ groups were randomized 1:1 to receive either the standard GLB™ program + population-based lifestyle advice for weight management, or a modified GLB™ program + personalized, genetic-based lifestyle advice for weight management. The purpose of this study is to determine if the provision of genetic-based lifestyle guidelines is superior to the provision of population-based guidelines in a pragmatic clinical setting to promote changes in: body composition, weight, body mass index, dietary and physical activity habits, as well as attitudes, subjective norms, and behavioural control. The 12-month intervention protocol consists of 23 group-based sessions and 4 one-on-one sessions. Data collection time points include baseline in addition to 3, 6, and 12-month follow up. The comprehensive study design is described in the present manuscript, using both the extended CONSORT checklist for reporting pragmatic trials and the SPIRIT checklist as guidance during manuscript development. DISCUSSION: Overall, this study seeks to pragmatically determine if the provision of DNA-based lifestyle advice leads to improved health and lifestyle outcomes compared to the provision of standard, population-based lifestyle advice. The results of this trial can be used to inform clinical and community nutrition practice guidelines. TRIAL REGISTRATION: This study was registered with clinicaltrials.gov : NCT03015012 on January 9, 2017.

Geospatial analyses of adverse birth outcomes in Southwestern Ontario: Examining the impact of environmental factors.

BACKGROUND: A growing body of research has examined the association between exposure to environmental factors during pregnancy and adverse birth outcomes; however, many studies do not control for potential covariates and findings vary considerably. OBJECTIVE: To test the relative influence of environmental factors including exposure to air pollution, major roads, highways, industry, parks, greenspaces, and food retailers on low birth weight (LBW) and preterm birth (PTB) in Southwestern Ontario (SWO), Canada, while accounting for medical (e.g., previous preterm birth, gestational diabetes), behavioral (e.g., alcohol, smoking), demographic (e.g., maternal age, body mass index), and neighborhood-level socioeconomic (e.g., household income, education) factors. METHODS: This retrospective cohort study consisted of a large sample of pregnant women from SWO who gave birth to singleton newborns between February 2009 and February 2014 at London Health Sciences Centre. Data on maternal postal codes were entered into a Geographic Information System to map the distribution of maternal residences and determine selected characteristics of their neighborhood environments (i.e., socioeconomic, built, natural). These variables were developed based on postal codes where the mothers lived prior to giving birth. Logistic regression was used to assess the relative effects of the physical environment, socioeconomic status, clinical history, and behavioral risk factors on mothers having a LBW or PTB infant. RESULTS: Out of 25,263 live births, 5.7% were LBW and 7.5% were PTB. Exposure to sulfur dioxide was a top predictor of both LBW and PTB. For every one-unit increase in sulfur dioxide, the odds of a LBW and PTB were 3.4 (95% CI: 2.2, 5.2) and 2.0 (95% CI: 1.4, 3.0) times higher, after controlling for other variables in the model, respectively (p < 0.001). Previous PTB was also highly associated with both birth outcomes. CONCLUSIONS: Health care providers should be informed about the hazards of air pollution to developing fetuses so that recommendations can be made to their pregnant patients about limiting exposure when air quality is poor.

Is phase angle an appropriate indicator of malnutrition in different disease states? A systematic review.

BACKGROUND & AIMS: Subjective Global Assessment (SGA) classifies malnutrition severity via a simple bedside assessment. Phase angle (PhA) is an indicator of cell integrity and has been suggested to be indicator of nutritional status. OBJECTIVE: To explore the relationship between PhA and SGA. METHODS: Relevant studies published through October 31, 2017 were identified using 7 electronic databases. Articles were included for review if they included comparison data between SGA and PhA within adult disease populations. Evidence quality was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) guidelines and methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. RESULTS: 33 articles within four disease states (liver, hospitalization, oncology and renal) met inclusion criteria for review. Results were limited by restricting the database search to articles published in English only, and by the inherent difficulty of comparing 2 methods which are both influenced by the operator. CONCLUSION: Based on GRADE guidelines, evidence quality received a grade of Low. Based on QUADAS-2, 61% of studies had high risk of bias in the index test (PhA), while all other domains had low risk. It is not possible to conclude that PhA is an accurate independent indicator of malnutrition. PROSPERO no. CRD42016050876.

A Systematic Review of Genetic Testing and Lifestyle Behaviour Change: Are We Using High-Quality Genetic Interventions and Considering Behaviour Change Theory?

BACKGROUND: Studying the impact of genetic testing interventions on lifestyle behaviour change has been a priority area of research in recent years. Substantial heterogeneity exists in the results and conclusions of this literature, which has yet to be explained using validated behaviour change theory and an assessment of the quality of genetic interventions. The theory of planned behaviour (TPB) helps to explain key contributors to behaviour change. It has been hypothesized that personalization could be added to this theory to help predict changes in health behaviours. PURPOSE: This systematic review provides a detailed, comprehensive identification, assessment, and summary of primary research articles pertaining to lifestyle behaviour change (nutrition, physical activity, sleep, and smoking) resulting from genetic testing interventions. The present review further aims to provide in-depth analyses of studies conducted to date within the context of the TPB and the quality of genetic interventions provided to participants while aiming to determine whether or not genetic testing facilitates changes in lifestyle habits. This review is timely in light of a recently published "call-to-action" paper, highlighting the need to incorporate the TPB into personalized healthcare behaviour change research. METHODS: Three bibliographic databases, one key website, and article reference lists were searched for relevant primary research articles. The PRISMA Flow Diagram and PRISMA Checklist were used to guide the search strategy and manuscript preparation. Out of 32,783 titles retrieved, 26 studies met the inclusion criteria. Three quality assessments were conducted and included: (1) risk of bias, (2) quality of genetic interventions, and (3) consideration of theoretical underpinnings - primarily the TPB. RESULTS: Risk of bias in studies was overall rated to be "fair." Consideration of the TPB was "poor," with no study making reference to this validated theory. While some studies (n = 11; 42%) made reference to other behaviour change theories, these theories were generally mentioned briefly, and were not thoroughly incorporated into the study design or analyses. The genetic interventions provided to participants were overall of "poor" quality. However, a separate analysis of studies using controlled intervention research methods demonstrated the use of higher-quality genetic interventions (overall rated to be "fair"). The provision of actionable recommendations informed by genetic testing was more likely to facilitate behaviour change than the provision of genetic information without actionable lifestyle recommendations. Several studies of good quality demonstrated changes in lifestyle habits arising from the provision of genetic interventions. The most promising lifestyle changes were changes in nutrition. CONCLUSIONS: It is possible to facilitate behaviour change using genetic testing as the catalyst. Future research should ensure that high-quality genetic interventions are provided to participants, and should consider validated theories such as the TPB in their study design and analyses. Further recommendations for future research are provided.

Home safe home: Evaluation of a childhood home safety program.

BACKGROUND: The London Health Sciences Centre Home Safety Program (HSP) provides safety devices, education, a safety video, and home safety checklist to all first-time parents for the reduction of childhood home injuries. The objective of this study was to evaluate the HSP for the prevention of home injuries in children up to 2 years of age. METHODS: A program evaluation was performed with follow-up survey, along with an interrupted time series analysis of emergency department (ED) visits for home injuries 5 years before (2007-2013) and 2 years after (2013-2015) implementation. Spatial analysis of ED visits was undertaken to assess differences in home injury rates by dissemination areas controlling differences in socioeconomic status (i.e., income, education, and lone-parent status) at the neighborhood level. RESULTS: A total of 3,458 first-time parents participated in the HSP (a 74% compliance rate). Of these, 20% (n = 696) of parents responded to our questionnaire, with 94% reporting the program to be useful (median, 6; interquartile range, 2 on a 7-point Likert scale) and 81% learning new strategies for preventing home injuries. The median age of the respondent's babies were 12 months (interquartile range, 1). The home safety check list was used by 87% of respondents to identify hazards in their home, with 95% taking action to minimize the risk. The time series analysis demonstrated a significant decline in ED visits for home injuries in toddlers younger than2 years of age after HSP implementation. The declines in ED visits for home injuries remained significant over and above each socioeconomic status covariate. CONCLUSION: Removing hazards, supervision, and installing safety devices are key facilitators in the reduction of home injuries. Parents found the HSP useful to identify hazards, learn new strategies, build confidence, and provide safety products. Initial finding suggests that the program is effective in reducing home injuries in children up to 2 years of age. LEVEL OF EVIDENCE: Therapeutic/care management study, level V.

An evidence-based method for targeting an abusive head trauma prevention media campaign and its evaluation.

BACKGROUND: A triple-dose abusive head trauma (AHT) prevention program (Period of PURPLE Crying) was implemented. The third dose consisted of an education media campaign. The study objectives were to describe the qualitative and spatial methods developed to target AHT prevention and to evaluate this campaign. METHODS: A questionnaire on the level of importance of factors, rated on a 7-point Likert scale, was distributed to a panel of experts to determine the best advertising locations. Ranked factors were used to create weights for statistical modeling and mapping within a Geographic Information Systems to determine optimal ad locations. The media campaign was evaluated via a telephone survey of randomly selected households. RESULTS: The survey found locations of new families, high population density, and high percentage of lone parents to be the most important factors for selecting billboard sites. Spatial analysis revealed six areas that ranked highest in our factors. Five billboards, four media posters, and six transit shelters were selected for our advertisements. A population-based telephone survey revealed that 23% of respondents knew the campaign. Nearly half (42%) heard the radio public service announcements, and 9% saw billboards. CONCLUSION: Extending primary prevention efforts to the public helps to create a cultural change in the way inconsolable crying, the trigger for AHT, is viewed. With the use of ranked factors and Geographic Information Systems, geographic locations with high visibility and specific risk factors for AHT were identified for targeting the campaign, facilitating the likelihood that our message was reaching the population in greatest need.

An epidemiologic profile of pediatric concussions: identifying urban and rural differences.

BACKGROUND: The objective of this study was to describe the epidemiology of concussions presenting to the emergency department (ED). METHODS: A retrospective cohort of concussions for pediatric (age < 18 years) patients treated in the ED of a regional pediatric Level 1 trauma center from 2006 to 2011 was examined. Descriptive and geographic analyses were completed, with comparisons by age groups and residence (urban/rural). RESULTS: There were a total of 2,112 treated pediatric concussions. Two thirds of the concussions occurred in males (67%), with a median age of 13 years (interquartile range [IQR], 6). Nearly half of the pediatric concussions were sports related (48%); 36% of these concussions were from hockey. Significant differences were found in the distribution of the mechanism of injury across age groups (p < 0.001). Falls were most prevalent among young children, and sports concussions, for children 10 years and older. Two fifths of concussions occurred during winter months. Discharge disposition significantly differed by age (p < 0.001), with home discharge increasing with age up to 14 years. There were a total of 387 rural (19%) and 1,687 urban (81%) concussed patients, for a mean ED concussion visit rate of 2.2 per 1,000 and 3.5 per 1,000, respectively. Rural patients were older (14 [IQR, 6] vs. 13 [IQR, 6], p = 0.019] and sustained 2.5 times more concussions from a motor vehicle crash compared with urban youth patients (p < 0.001). CONCLUSION: Males in early adolescence are at highest risk for concussion, particularly from sport-related activities. Urban and rural children have differences in their etiology and severity of concussions. Concussions are predictable, and their prevention should be targeted based on epidemiologic and environmental data. LEVEL OF EVIDENCE: Epidemiologic, study, level III.

A comparison of injuries, crashes, and outcomes for pediatric rear occupants in traffic motor vehicle collisions.

BACKGROUND: This study was initiated was initiated to describe pediatric rear-occupant motor vehicle collision (MVC) injuries, including injury patterns and outcomes as well as characteristics associated with severe injury to the head and abdomen. METHODS: A retrospective cohort of severely injured (Injury Severity Score [ISS] > 12) pediatric (age <18 years) patients involved in a traffic MVC as a rear occupant and treated at one of two Ontario trauma centers (2001-2010) was studied was studied. Demographic, injury, crash and outcome data were obtained from the trauma registries. Data were statistically compared by two pediatric age groups: children (0-8 years; requiring a child or booster seat) versus adolescents (9-17 years; requiring a lap-shoulder belt). RESULTS: There were 36 children (34%) and 70 adolescents (66%) severely injured as rear occupants in MVCs. Despite similar ISS (p = 0.716) and mortality rates (p = 0.680) between age groups, there were significant differences in injury patterns and risk factors. Children were more likely to have severe head injuries (78% vs. 39%, p < 0.001) associated with a lack of an age-appropriate child restraints (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.1-10.8; p = 0.029), middle seating (OR, 6.2; 95% CI, 1.5-26.1; p = 0.013), and side-impact crashes (p = 0.007). Adolescents were more likely to have severe abdominal injuries (23% vs. 6%, p < 0.001) associated with the use of lap-shoulder belts (OR, 3.8; 95% CI, 1.1-13.3; p = 0.034), single-vehicle MVCs (p = 0.007), and vehicle extrications (p = 0.035). CONCLUSION: While safer than the front seat for children, additional study is needed on the restraint systems and the potential for injury to pediatric rear occupants in an MVC. Our data suggest that pediatric age groups differ in injuries, risk factors, and MVC impacts. Recommendations for improved protection of child occupants and preferred seating positions are required. LEVEL OF EVIDENCE: Epidemiologic study, level III.

Physical activity levels of older community-dwelling adults are influenced by summer weather variables.

Adequate daily physical activity (PA) is important for maintaining functional capacity and independence in older adults. However, most older adults in Canada do not engage in enough PA to sustain fitness and functional independence. Environmental influences, such as warmer daytime temperatures, may influence PA participation; however, few studies have examined the effect of summertime temperatures on PA levels in older adults. This investigation measured the influence of summertime weather variables on PA in 48 community-dwelling older adults who were randomly recruited from a local seniors' community centre. Each participant wore an accelerometer for a single 7-consecutive-day period (between 30 May and 9 August 2006) during waking hours, and completed a PA logbook to remark on major daily PA events. Local weather variables were collected from a national weather service and compared with PA counts per minute. Regression analysis revealed a curvilinear relationship between log-transformed PA and mean daily temperature (r2 = 0.025; p < 0.05). Linear mixed effects models that accounted for repeated measures nested within individuals were performed for monthly periods, meteorological variables, sex, age, and estimated maximal oxygen consumption, with PA as the dependent variable. Age and Air Quality Index remained significant variables within the model. Higher fitness levels had no effect on allowing individuals to perform more vigorous PA in warmer temperatures.