Physical environment features that predict outdoor active play can be measured using Google Street View images.

BACKGROUND: Childrens' outdoor active play is an important part of their development. Play behaviour can be predicted by a variety of physical and social environmental features. Some of these features are difficult to measure with traditional data sources. METHODS: This study investigated the viability of a machine learning method using Google Street View images for measurement of these environmental features. Models to measure natural features, pedestrian traffic, vehicle traffic, bicycle traffic, traffic signals, and sidewalks were developed in one city and tested in another. RESULTS: The models performed well for features that are time invariant, but poorly for features that change over time, especially when tested outside of the context where they were initially trained. CONCLUSION: This method provides a potential automated data source for the development of prediction models for a variety of physical and social environment features using publicly accessible street view images.

Influence of Neighborhood Built Environments on the Outdoor Free Play of Young Children: a Systematic, Mixed-Studies Review and Thematic Synthesis.

Urban environments shape early childhood exposures, experiences, and health behaviors, including outdoor free play, influencing the physical, cognitive, social, and emotional development of young children. We examined evidence for urban or suburban built environment influences on outdoor free play in 0-6-year-olds, considering potential differences across gender, culture, and geography. We systematically searched seven literature databases for relevant qualitative, quantitative, and mixed methods studies: of 5740 unique studies, 53 met inclusion criteria. We assessed methodological quality and thematically synthesized findings from included studies. Three broad themes, features of spaces for play, routes, and social factors intersected to influence the availability, accessibility, and acceptability of neighborhoods for young children's outdoor free play across diverse cultural and geographic contexts. Proximity to formal or informal space for play, protection from traffic, pedestrian environment, green and natural environments, and opportunity for social connection supported outdoor free play. Family and community social context influenced perceptions of and use of space; however, we did not find consistent, gendered differences in built environment correlates of outdoor free play. Across diverse contexts, playable neighborhoods for young children provided nearby space for play, engaging routes protected from traffic and facilitated frequent interaction between people, nature, and structures.

Social determinants of playing outdoors in the neighbourhood: family characteristics, trust in neighbours and daily outdoor play in early childhood.

OBJECTIVES: The goal of this study was to investigate socio-demographic and contextual factors in relation to the frequency of outdoor play in the neighbourhood in early childhood, drawing from a large sample of children in British Columbia, Canada. METHODS: Parents/caregivers of 2280 4- to 5-year-old children completed the Childhood Experiences Questionnaire (CHEQ) in 2018. Binary logistic regression analyses were conducted to predict the likelihood of children participating in everyday outdoor play in their neighbourhood based on the child's gender, family ethnicity (i.e., European origin vs. other), household income (i.e., less vs. equal/more than CDN$75,000), population centre (i.e., urban vs. rural) and parent's trust in neighbours (i.e., trusting vs. not trusting neighbours to look out for children). RESULTS: Thirty-five percent of children in this study met recommendations of playing outdoors every day. Children whose parents perceived strong trust in neighbours were twice as likely to play outdoors in their neighbourhood every day, when compared with those whose parents perceived low trust in neighbours. Additionally, children from families with higher incomes (equal/more than $75,000) were significantly more likely to play outdoors daily than those with lower incomes, but only if they resided in rural areas. Last, children with European family backgrounds were 64% more likely to play outdoors every day compared with those with non-European backgrounds. CONCLUSION: Findings from this study contribute to an emerging body of work examining socio-economic, demographic and contextual factors associated with children meeting the recommendations for everyday outdoor play in their neighbourhood.

RéSUMé: OBJECTIFS: Le but de la présente étude était d'étudier les facteurs sociodémographiques et contextuels liés à la fréquence de jeu en plein air dans le quartier pendant la petite enfance, à partir d'un vaste échantillon d'enfants de la Colombie-Britannique, au Canada. MéTHODES: Les responsables de 2 280 enfants de quatre à cinq ans ont rempli le Childhood Experiences Questionnaire (CHEQ) en 2018. Des analyses de régression logistique binaire ont été effectuées pour prédire la probabilité que les enfants participent à des jeux extérieurs quotidiens en fonction du genre de l'enfant, de l'origine ethnique de la famille (c.-à-d. origine européenne ou autre), du revenu du foyer (c.-à-d. inférieur ou égal/supérieur à 75 000 $ CA), du centre de la population (c.-à-d. urbain ou rural) et de la confiance des parents envers les voisins (c.-à-d. confiance ou non dans les voisins pour veiller sur les enfants). RéSULTATS: Trente-cinq pour cent des enfants ont joué dehors au quotidien. Les enfants dont les parents ont perçu une forte confiance dans les voisins étaient deux fois plus probables de jouer dehors. De plus, les enfants issus de familles aux revenus plus élevés étaient nettement plus susceptibles de jouer dehors, mais seulement s'ils résidaient dans des régions rurales. Enfin, les enfants de familles européennes étaient 64 % plus probables de jouer dehors au quotidien. CONCLUSION: Les résultats de cette étude contribuent à un nouveau corpus de recherches examinant les facteurs socio-économiques, démographiques et contextuels associés au jeu en plein air au quotidien pendant la petite enfance.

Validating injury burden estimates using population birth cohorts and longitudinal cohort studies of injury outcomes: the VIBES-Junior study protocol.

INTRODUCTION: Traumatic injury is a leading contributor to the global disease burden in children and adolescents, but methods used to estimate burden do not account for differences in patterns of injury and recovery between children and adults. A lack of empirical data on postinjury disability in children has limited capacity to derive valid disability weights and describe the long-term individual and societal impacts of injury in the early part of life. The aim of this study is to establish valid estimates of the burden of non-fatal injury in children and adolescents. METHODS AND ANALYSIS: Five longitudinal studies of paediatric injury survivors <18 years at the time of injury (Australia, Canada, UK and USA) and two whole-of-population linked administrative data paediatric studies (Australia and Wales) will be analysed over a 3-year period commencing 2018. Meta-analysis of deidentified patient-level data (n≈2,600) from five injury-specific longitudinal studies (Victorian State Trauma Registry; Victorian Orthopaedic Trauma Outcomes Registry; UK Burden of Injury; British Columbia Children's Hospital Longitudinal Injury Outcomes; Children's Health After Injury) and >1 million children from two whole-of-population cohorts (South Australian Early Childhood Data Project and Wales Electronic Cohort for Children). Systematic analysis of pooled injury-specific cohort data using a variety of statistical techniques, and parallel analysis of whole-of-population cohorts, will be used to develop estimated disability weights for years lost due to disability, establish appropriate injury classifications and explore factors influencing recovery. ETHICS AND DISSEMINATION: The project was approved by the Monash University Human Research Ethics Committee project number 12 311. Results of this study will be submitted for publication in internationally peer-reviewed journals. The findings from this project have the capacity to improve the validity of paediatric injury burden measurements in future local and global burden of disease studies.

Hospitalizations due to unintentional transport injuries among Aboriginal population of British Columbia, Canada: Incidence, changes over time and ecological analysis of risk markers.

BACKGROUND: Worldwide, Indigenous people have disproportionately higher rates of transport injuries. We examined disparities in injury-related hospitalizations resulting from transport incidents for three population groups in British Columbia (BC): total population, Aboriginal off-reserve, and Aboriginal on-reserve populations. We also examined sociodemographic, geographic and ethnic risk markers for disparities. METHODS: We identified Aboriginal people through BC's universal health care insurance plan insurance premium group and birth and death record notations. We calculated crude incidence rate and Standardized Relative Risk (SRR) of hospitalization for unintentional transport injury, standardized for age, gender and Health Service Delivery Area (HSDA), relative to the total population of BC. We tested hypothesized associations of geographic, socio-economic, and employment-related characteristics of Aboriginal communities with SRR of transport injury by multivariable linear regression. RESULTS: During the period 1991-2010, the SRR for the off-reserve Aboriginal population was 1.77 (95% CI: 1.71 to 1.83); and 2.00 (95% CI: 1.93 to 2.07) among those living on-reserve. Decline in crude rate and SRRs was observed over this period among both the Aboriginal and total populations of BC, but was proportionally greater among the Aboriginal population. The best-fitting multivariable risk marker model was an excellent fit (R2 = 0.912, p<0.001), predicted SRRs very close to observed values, and retained the following terms: urban residence, population per room, proportion of the population with a high school certificate, proportion of the population employed; and multiplicative interactions of Aboriginal ethnicity with population per room and proportion of the population employed. CONCLUSIONS: Disparities in risk of hospitalization due to unintentional transport injury have narrowed. Aboriginal ethnicity modifies the effects of socioeconomic risk factors. Continued improvement of socioeconomic conditions and implementation of culturally relevant injury prevention interventions are needed.

Intentional injury among the indigenous and total populations in British Columbia, Canada: trends over time and ecological analyses of risk.

BACKGROUND: Our objective was to explore intentional injury disparity between Indigenous populations and the total population in the province of British Columbia (BC), Canada. We focus on hospitalizations, including both self-inflicted injuries and injuries inflicted by others. METHODS: We used data from BC's universal health care insurance plan, 1991 to 2010, linked to Vital Statistics databases. Indigenous people were identified through the insurance premium group, and birth and death records. Place of residence was identified through postal code. We calculated crude hospitalization incidence rates and the Standardized Relative Risk (SRR) of hospitalization, standardized by gender, 5-year age group, and Health Service Delivery Area (HSDA). With HSDA populations as the units of observation, linear regression was used to test hypothesized associations of Indigenous ethnicity, geographic, and socio-economic characteristics with SRR of injury. RESULTS: During the period 1991-2010, the crude rate of hospitalization for intentional injuries was 8.4 per 10,000 person-years (95% confidence interval (CI): 8.3 to 8.5) for the total BC population, compared to 45.3 per 10,000 (95% CI: 44.5 to 46.1) for the Indigenous population. For both populations, risk declined over the period for injuries self-inflicted and inflicted by others. The linear regression model predicts that the off-reserve Indigenous population will have SRR of intentional injury 3.98 greater, and the on-reserve Indigenous population 4.17, greater than the total population. The final model was an excellent fit (R2 = 0.912, F = 177.632, p < 0.001), and found that three variables - occupational risk, high school diploma, and university degree - each provide independent effects when interacting multiplicatively with Indigenous ethnicity. CONCLUSIONS: The observation of substantially declining rates of intentional injury for both the Indigenous and total BC populations is off-set by the high disparity in risk between the two populations, which will likely continue until Canada reduces disparity with respect to discriminatory practices, and physical, social, and economic conditions.

Risk of Hospitalization Due to Unintentional Fall Injury in British Columbia, Canada, 1999-2008: Ecological Associations with Socioeconomic Status, Geographic Place, and Aboriginal Ethnicity.

BACKGROUND: Aboriginal people in British Columbia (BC), especially those residing on Indian reserves, have higher risk of unintentional fall injury than the general population. We test the hypothesis that the disparities are attributable to a combination of socioeconomic status, geographic place, and Aboriginal ethnicity. METHODS: Within each of 16 Health Service Delivery Areas in BC, we identified three population groups: total population, Aboriginal off-reserve, and Aboriginal on-reserve. We calculated age and gender-standardized relative risks (SRR) of hospitalization due to unintentional fall injury (relative to the total population of BC), during time periods 1999-2003 and 2004-2008, and we obtained custom data from the 2001 and 2006 censuses (long form), describing income, education, employment, housing, proportions of urban and rural dwellers, and prevalence of Aboriginal ethnicity. We studied association of census characteristics with SRR of fall injury, by multivariable linear regression. RESULTS: The best-fitting model was an excellent fit (R 2 = 0.854, p < 0.001) and predicted SRRs very close to observed values for the total, Aboriginal off-reserve, and Aboriginal on-reserve populations of BC. After stepwise regression, the following terms remained: population per room, urban residence, labor force participation, income per capita, and multiplicative interactions of Aboriginal ethnicity with population per room and labor force participation. CONCLUSIONS: The disparities are predictable by the hypothesized risk markers. Aboriginal ethnicity is not an independent risk marker: it modifies the effects of socioeconomic factors. Closing the gap in fall injury risk between the general and Aboriginal populations is likely achievable by closing the gaps in socioeconomic conditions.

Injury hospitalizations due to unintentional falls among the Aboriginal population of British Columbia, Canada: incidence, changes over time, and ecological analysis of risk markers, 1991-2010.

BACKGROUND: Aboriginal people in British Columbia (BC) have higher injury incidence than the general population. Our project describes variability among injury categories, time periods, and geographic, demographic and socio-economic groups. This report focuses on unintentional falls. METHODS: We used BC's universal health care insurance plan as a population registry, linked to hospital separation and vital statistics databases. We identified Aboriginal people by insurance premium group and birth and death record notations. We identified residents of specific Aboriginal communities by postal code. We calculated crude incidence and Standardized Relative Risk (SRR) of hospitalization for unintentional fall injury, standardized for age, gender and Health Service Delivery Area (HSDA), relative to the total population of BC. We tested hypothesized associations of geographic, socio-economic, and employment-related characteristics with community SRR of injury by linear regression. RESULTS: During 1991 through 2010, the crude rate of hospitalization for unintentional fall injury in BC was 33.6 per 10,000 person-years. The Aboriginal rate was 49.9 per 10,000 and SRR was 1.89 (95% confidence interval 1.85-1.94). Among those living on reserves SRR was 2.00 (95% CI 1.93-2.07). Northern and non-urban HSDAs had higher SRRs, within both total and Aboriginal populations. In every age and gender category, the HSDA-standardized SRR was higher among the Aboriginal than among the total population. Between 1991 and 2010, crude rates and SRRs declined substantially, but proportionally more among the Aboriginal population, so the gap between the Aboriginal and total population is narrowing, particularly among females and older adults. These community characteristics were associated with higher risk: lower income, lower educational level, worse housing conditions, and more hazardous types of employment. CONCLUSIONS: Over the years, as socio-economic conditions improve, risk of hospitalization due to unintentional fall injury has declined among the Aboriginal population. Women and older adults have benefited more.

Can child injury prevention include healthy risk promotion?

To reflect on the role of risk-taking and risky play in child development and consider recommendations for the injury prevention field, a symposium was held prior to the November 2013 Canadian Injury Prevention and Safety Promotion Conference. Delegates heard from Canadian and international researchers, practitioners and play safety experts on child development, play space design and playground safety, provision of recreation, and legal and societal perceptions of risk and hazard. The presenters provided multidisciplinary evidence and perspectives indicating the potential negative effect on children's development of approaches to injury prevention that prioritise safety and limit children's opportunities for risky play. Delegates considered the state of the field of injury prevention and whether alternative approaches were warranted. Each presenter prepared a discussion paper to provide the opportunity for dialogue beyond attendees at the symposium. The resulting discussion papers provide a unique opportunity to consider and learn from multiple perspectives in order to develop a path forward.

Fathers' views on their financial situations, father-child activities, and preventing child injuries.

Unintentional injuries are a leading public health problem for children, particularly among those living at lower socioeconomic levels. Parents play an important preventive role, and the aim of this study was to examine fathers' views on the role of their family financial situation in preventing children's injuries. In-depth interviews were conducted with 15 fathers of children 2 to 7 years living in western Canada. Questions solicited fathers' views about their financial situation and their child injury prevention efforts. Data analysis was underpinned by masculinity theory and guided by constant comparative grounded theory methods. Findings included that fathers living with fewer financial limitations emphasized use of safety equipment and aligned themselves with provider and protector masculine ideals. Fathers with moderate financial constraint described more child-centered safety efforts and efforts to manage finances. Those facing greatest constraint demonstrated aspects of marginalized masculinities, whereby they acknowledged their economic provider limitations while strongly aligning with the protector role. These findings hold relevance for development of interventions aimed at reducing child injury risk inequities. Taking into account how masculinities may shape their beliefs and practices can inform design of father-centered interventions for men living at different points on the socioeconomic spectrum.

Worker compensation injuries among the Aboriginal population of British Columbia, Canada: incidence, annual trends, and ecological analysis of risk markers, 1987-2010.

BACKGROUND: Aboriginal people in British Columbia (BC) have higher injury incidence than the general population, but information is scarce regarding variability among injury categories, time periods, and geographic, demographic and socio-economic groups. Our project helps fill these gaps. This report focuses on workplace injuries. METHODS: We used BC's universal health care insurance plan as a population registry, linked to worker compensation and vital statistics databases. We identified Aboriginal people by insurance premium group and birth and death record notations. We identified residents of specific Aboriginal communities by postal code. We calculated crude incidence rate and Standardized Relative Risk (SRR) of worker compensation injury, adjusted for age, gender and Health Service Delivery Area (HSDA), relative to the total population of BC. We assessed annual trend by regressing SRR as a linear function of year. We tested hypothesized associations of geographic, socio-economic, and employment-related characteristics of Aboriginal communities with community SRR of injury by multivariable linear regression. RESULTS: During the period 1987-2010, the crude rate of worker compensation injury in BC was 146.6 per 10,000 person-years (95% confidence interval: 146.4 to 146.9 per 10,000). The Aboriginal rate was 115.6 per 10,000 (95% CI: 114.4 to 116.8 per 10,000) and SRR was 0.88 (95% CI: 0.87 to 0.89). Among those living on reserves SRR was 0.79 (95% CI: 0.78 to 0.80). HSDA SRRs were highly variable, within both total and Aboriginal populations. Aboriginal males under 35 and females under 40 years of age had lower SRRs, but older Aboriginal females had higher SRRs. SRRs are declining, but more slowly for the Aboriginal population. The Aboriginal population was initially at lower risk than the total population, but parity was reached in 2006. These community characteristics independently predicted injury risk: crowded housing, proportion of population who identified as Aboriginal, and interactions between employment rate and income, occupational risk, proportion of university-educated persons, and year. CONCLUSIONS: As employment rates rise, so has risk of workplace injury among the Aboriginal population. We need culturally sensitive prevention programs, targeting regions and industries where Aboriginal workers are concentrated and demographic groups that are at higher risk.

The advocacy for pedestrian safety study: cluster randomised trial evaluating a political advocacy approach to reduce pedestrian injuries in deprived communities.

OBJECTIVE: To determine whether advocacy targeted at local politicians leads to action to reduce the risk of pedestrian injury in deprived areas. DESIGN: Cluster randomised controlled trial. SETTING: 239 electoral wards in 57 local authorities in England and Wales. PARTICIPANTS: 617 elected local politicians. INTERVENTIONS: Intervention group politicians were provided with tailored information packs, including maps of casualty sites, numbers injured and a synopsis of effective interventions. MAIN OUTCOME MEASURES: 25-30 months post intervention, primary outcomes included: electoral ward level: percentage of road traffic calmed; proportion with new interventions; school level: percentage with 20 mph zones, Safe Routes to School, pedestrian training or road safety education; politician level: percentage lobbying for safety measures. Secondary outcomes included politicians' interest and involvement in injury prevention, and facilitators and barriers to implementation. RESULTS: PRIMARY OUTCOMES DID NOT SIGNIFICANTLY DIFFER: % difference in traffic calming (0.07, 95%CI: -0.07 to 0.20); proportion of schools with 20 mph zones (RR 1.47, 95%CI: 0.93 to 2.32), Safe Routes to School (RR 1.34, 95%CI: 0.83 to 2.17), pedestrian training (RR 1.23, 95%CI: 0.95 to 1.61) or other safety education (RR 1.16, 95%CI: 0.97 to 1.39). Intervention group politicians reported greater interest in child injury prevention (RR 1.09, 95%CI 1.03 to 1.16), belief in potential to help prevent injuries (RR 1.36, 95%CI 1.16 to 1.61), particularly pedestrian safety (RR 1.55, 95%CI 1.19 to 2.03). 63% of intervention politicians reported supporting new pedestrian safety schemes. The majority found the advocacy information surprising, interesting, effectively presented, and could identify suitable local interventions. CONCLUSIONS: This study demonstrates the feasibility of an innovative approach to translational public health by targeting local politicians in a randomised controlled trial. The intervention package was positively viewed and raised interest but changes in interventions were not statistically significance. Longer term supported advocacy may be needed. TRIAL REGISTRATION: Current Controlled Trials ISRCTN91381117.

International policies on alcohol impaired driving: are legal blood alcohol concentration (BAC) limits in motorized countries compatible with the scientific evidence?

Borkenstein et al. (1974) study indicated that drivers with BACs of 0.05 to 0.09 per cent were twice as likely to crash as drivers with a zero BAC. Drivers with BACs from 0.10 to 0.14 per cent were ten times as likely to have a fatal crash in 1964. There have been numerous efforts during the history of motorized countries to control the consumption of alcohol and the problems associated with it through legislative mandate, it was not until the 1970s that acceptance of legal BAC (Blood Alcohol Concentration) limits laws became widespread. In particular, as more and more people drive automobiles, the number of traffic accidents involving drunken drivers has soared, and many of these are known to be related to the consumption of alcohol. Thus, legislators find themselves under increasing pressure to find a reasonable and fair solution to the question of alcohol impaired driving, as the scientific evidence about alcohol consumption level and psycho motor functions impairment came to clear. A landmark event in the development of policies regarding impaired driving was the establishment of the fact that consumption of alcohol does, in fact, increase the probability of traffic crashes. Legal limit laws specify a maximum permissible BAC limit for drivers. Currently, a BAC laws range from zero tolerance and 0.02 to 0.10% constitutes prima facie evidence in most countries for 'Driving under Influence of Alcohol.' This latter standard is too permissive, as driving skills deteriorate and crash involvement risk increases beginning at 0.02%. There are consequences attached to setting a BAC limit so high that a 72 kg man can drink five bottles of beer and still be under legal limit. In this sense high legal BAC limit may influence people to make bad estimates of their relative risk of injury or death while driving. Provided there is adequate political will, millions of lives could be saved in the coming years. This review is an attempt to examine in detail the available information about legal BAC limit laws, and issue of considerable interest to both policy makers and the public.