Traffic-Calming Measures and Road Traffic Collisions and Injuries: a Spatiotemporal Analysis.

Traffic-calming measures (TCMs) are physical modifications to the road network aimed at making the roads safer. Although studies have reported reductions in road crashes and injuries tied to the presence of TCMs, they have been criticized for their pre-post designs. This study aims to complement our knowledge of TCMs effectiveness by assessing their impact using a longitudinal design. The implementation of eight TCMs, including curb extensions and speed humps, was evaluated at the intersections and census tract levels in Montreal, Canada from 2012 to 2019. The primary outcome was fatal or serious collisions among all road users. Inference was performed using a Bayesian implementation of Conditional Poisson regression in which random effects were used to account for the spatiotemporal variation in collisions. TCMs were generally implemented on local roads, although most collisions occurred on arterial roads. Overall, there was weak evidence that TCMs were associated with study outcomes. However, subgroup analyses of intersections on local roads suggested a reduction in collision rates due to TCMs (median IRR: 0.31; 95% Credible Interval: 0.12 - 0.86). To improve road safety, effective counterparts of TCMs on arterial roads must be identified and implemented.

Neighbourhood social deprivation and risk of prostate cancer.

BACKGROUND: Striking geographic variations in prostate cancer incidence suggest an aetiological role for spatially-distributed factors. We assessed whether neighbourhood social deprivation, which can reflect limited social contacts, unfavourable lifestyle and environmental exposures, is associated with prostate cancer risk. METHODS: In 2005-2012, we recruited 1931 incident prostate cancer cases and 1994 controls in a case-control study in Montreal, Canada. Lifetime residential addresses were linked to an area-based social deprivation index around recruitment (2006) and about 10 years earlier (1996). Logistic regression estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Men residing in areas characterised by greater social deprivation had elevated prostate cancer risks (ORs of 1.54 and 1.60 for recent and past exposures, respectively; highest vs lowest quintiles), independently from area- and individual-level confounders and screening patterns. The increase in risk with recent high social deprivation was particularly elevated for high-grade prostate cancer at diagnosis (OR 1.87, 95% CI 1.32-2.64). Associations were more pronounced for neighbourhoods with higher proportions of separated/divorced or widowed individuals in the past, and with higher percentages of residents living alone recently. CONCLUSIONS: These novel findings, suggesting that neighbourhood-level social deprivation increases the risk of prostate cancer, point out to potential targeted public health interventions.

Is higher school neighbourhood Walk Score associated with greater child pedestrian safety near schools?

Walk Score is a common index used to estimate how suitable the built environment is for walking. Although Walk Score has been extensively validated as a measure of walkability and walking, there are limited studies examining whether commonly used constructs of walkability are associated with traffic safety in children. This study examined the association between Walk Score and child pedestrian injury controlling for observed walking exposure in school zones in Calgary, Toronto and Montreal, Canada. Results indicate that a higher Walk Score was associated with more child pedestrian injuries in all three cities, even after controlling for walking exposure. School travel planning should consider established individual pedestrian collision risk and individual factors rather than assuming a highly walkable environment is also a safe pedestrian environment.

Blame attribution analysis of police motor vehicle collision reports involving child bicyclists.

BACKGROUND: Injuries resulting from collisions between a bicyclist and driver are preventable and have high economic, personal and societal costs. Studying the language choices used by police officers to describe factors responsible for child bicyclist-motor vehicle collisions may help shift prevention efforts away from vulnerable road users to motorists and the environment. The overall aim was to investigate how police officers attribute blame in child (≤18 years) bicycle-motor vehicle collision scenarios. METHODS: A document analysis approach was used to analyse Alberta Transportation police collision reports from Calgary and Edmonton (2016-2017). Collision reports were categorised by the research team according to perceived blame (child, driver, both, neither, unsure). Content analysis was then used to examine police officer language choices. A narrative thematic analysis of the individual, behavioural, structural and environmental factors leading to collision blame was then conducted. RESULTS: Of 171 police collision reports included, child bicyclists were perceived to be at fault in 78 reports (45.6%) and adult drivers were perceived at fault in 85 reports (49.7%). Child bicyclists were portrayed through language choices as being irresponsible and irrational, leading to interactions with drivers and collisions. Risk perception issues were also mentioned frequently in relation to poor decisions made by child bicyclists. Most police officer reports discussed road user behaviours, and children were frequently blamed for collisions. CONCLUSIONS: This work provides an opportunity to re-examine perceptions of factors related to motor vehicle and child bicyclist collisions with a view to prevention.

Neighborhood built environment typologies and adiposity in children and adolescents.

BACKGROUND/OBJECTIVES: Neighborhoods are complex, multidimensional systems. However, the interrelation between multiple neighborhood dimensions is seldom considered in relation to youth adiposity. We created a neighborhood typology using a range of built environment features and examined its association with adiposity in youth. SUBJECTS/METHODS: Analyses are based on data from the QUALITY cohort, an ongoing study on the natural history of obesity in Quebec youth with a history of parental obesity. Adiposity was measured at baseline (8-10 years) and follow up, ~8 years later. Neighborhood features were measured at baseline through in-person neighborhood assessments and geocoded administrative data and were summarized using principal components analysis. Neighborhood types were identified using cluster analysis. Associations between neighborhood types and adiposity were examined using multivariable linear regressions. RESULTS: Five distinct neighborhood types characterized by levels of walkability and traffic-related safety were identified. At ages 8-10 years, children in moderate walkability/low safety neighborhoods had higher BMI Z-scores [ß: 0.41 (0.12; 0.71), p = 0.007], fat mass index [ß: 1.22 (0.29; 2.16), p = 0.010], waist circumference [ß: 4.92 (1.63; 8.21), p = 0.003], and central fat mass percentage [ß: 1.60 (0.04; 3.16), p = 0.045] than those residing in moderate walkability/high safety neighborhoods. Attenuated associations were observed between neighborhood types and adiposity 8 years later. Specifically, residents of moderate walkability/low safety neighborhoods had a higher FMI [ß: 1.42 (-0.07; 2.90), p = 0.062], and waist circumference [ß: 5.04 (-0.26; 10.34), p = 0.062]. CONCLUSIONS: Neighborhoods characterized by lower traffic safety appear to be the most obesogenic to children, regardless of other walkability-related features. Policies targeting neighborhood walkability for children may need to prioritize vehicular traffic safety.

Child pedestrian and cyclist injuries, and the built and social environment across Canadian cities: the Child Active Transportation Safety and the Environment Study (CHASE).

INTRODUCTION: Traffic injury is a leading and preventable cause of child death and disability, with child pedestrians and cyclists particularly vulnerable. Examining built environment correlates of child pedestrian and cyclist motor vehicle collisions (PCMVC) in different settings is needed to promote an evidence-based approach to road safety. METHODS: We conducted a cross-sectional study across multiple urban/suburban environments in Canada (Calgary, Toronto, Montreal, Laval, Peel Region). All public elementary schools were included (n=1030). We examined the role of land use/social environments, road environments and traffic safety interventions on the rates of child PCMVC within 1000 m of schools. Multivariable negative binomial regression was conducted for all cities and by individual city. In a subset of schools (n=389), we examined associations when controlling for active school transportation (AST). RESULTS: Mean PCMVC rate per school ranged from 0.13 collisions/year in Peel to 0.35 in Montreal. Child PCMVC were correlated with land use, social and road environments and traffic safety interventions. In fully adjusted models, social and land use features remained the most important correlates. New immigrant population had the largest positive association with child PCMVC (incidence rate ratio (IRR): 1.26, 95% CI 1.06 to 1.50), while old housing (pre-1960) density was most protective (IRR: 0.83, 95% CI 0.77 to 0.90). AST was associated with PCMVC, but it had no effect on the relationships between PCMVC and other social/environmental correlates. CONCLUSION: The built environment and social factors influence rates of child PCMVC. Opportunities to reduce child PCMVC exist through modifications to city design and road environments and implementing traffic safety interventions.

Active school transportation and the built environment across Canadian cities: Findings from the child active transportation safety and the environment (CHASE) study.

Walking and bicycling to school (active school transportation, AST) has been in decline for decades in North America and globally with the rise of automobility. This cross-sectional study estimated associations between the built environment and AST in seven Canadian communities. We observed the travel behaviours of almost 118,000 students at 552 schools. Using beta regression, we modeled the proportion of children using AST, considering built environment and social environment factors around schools. Across all schools, the average proportion of children using AST was 54.3% (SD 18.9%), with variability among cities from a low of 39.5% (SD 22.1%) in Laval, Quebec to 69.7% (SD 18.1%) in Montreal, Quebec. Overall, several modifiable road design features were associated with AST, including the presence of school crossing guards, cycling infrastructure, Walk Score® and traffic signal density. There was variability in the directionality and statistical significance of associations with design variables across cities, suggesting that the local context and directed local interventions are important to support AST. Natural experiment studies are necessary to examine local approaches related to the built environment to increase AST and ensure appropriate new policy and program interventions are developed.

State-of-the-art review: preventing child and youth pedestrian motor vehicle collisions: critical issues and future directions.

AIM: To undertake a comprehensive review of the best available evidence related to risk factors for child pedestrian motor vehicle collision (PMVC), as well as identification of established and emerging prevention strategies. METHODS: Articles on risk factors were identified through a search of English language publications listed in Medline, Embase, Transport, SafetyLit, Web of Science, CINHAL, Scopus and PsycINFO within the last 30 years (~1989 onwards). RESULTS: This state-of-the-art review uses the road safety Safe System approach as a new lens to examine three risk factor domains affecting child pedestrian safety (built environment, drivers and vehicles) and four cross-cutting critical issues (reliable collision and exposure data, evaluation of interventions, evidence-based policy and intersectoral collaboration). CONCLUSIONS: Research conducted over the past 30 years has reported extensively on child PMVC risk factors. The challenge facing us now is how to move these findings into action and intervene to reduce the child PMVC injury and fatality rates worldwide.

Spatial distribution of roadway environment features related to child pedestrian safety by census tract income in Toronto, Canada.

BACKGROUND: Investments in traffic calming infrastructure and other street design features can enhance pedestrian safety as well as contribute to the 'walkability' of neighbourhoods. Pedestrian-motor vehicle collisions (PMVCs) in urban areas, however, remain common and occur more frequently in lower income neighbourhoods. While risk and protective features of roadways related to PMVC have been identified, little research exists examining the distribution of roadway environment features. This study examined the relationship between roadway environment features related to child pedestrian safety and census tract income status in Toronto. METHODS: Spatial cluster detection based on 2006 census tract data identified low-income and high-income census tract clusters in Toronto. Police-reported PMVC data involving children between the ages of 5 and 14 years were mapped using geographical information system. Also mapped were roadway environment features (densities of speed humps, crossing guards, local roads, one-way streets and missing sidewalks). Multivariate logistic regression was used to examine the relationship between roadway environment features (independent variables) and cluster income status (dependent variable), controlling for child census tract population. RESULTS: There were significantly fewer speed humps and local roads in low-income versus high-income clusters. Child PMVC rates were 5.4 times higher in low-income versus high-income clusters. CONCLUSION: Socioeconomic inequities in the distribution of roadway environment features related to child pedestrian safety have policy and process implications related to the safety of child pedestrians in urban neighbourhoods.

Effect of reducing the posted speed limit to 30 km per hour on pedestrian motor vehicle collisions in Toronto, Canada - a quasi experimental, pre-post study.

BACKGROUND: Pedestrian related deaths have recently been on the rise in Canada. The effect of changing posted speeds on the frequency and severity of pedestrian motor vehicle collisions (PMVC) is not well studied using controlled quasi-experimental designs. The objective of this study was to examine the effect of lowering speed limits from 40 km/h to 30 km/h on PMVC on local roads in Toronto, Canada. METHODS: A 30 km/h speed limit on local roads in Toronto was implemented between January 2015 and December 2016. Streets that remained at a 40 km/h speed limit throughout the study period were selected as comparators. A quasi-experimental, pre-post study with a comparator group was used to evaluate the effect of the intervention on PMVC rates before and after the speed limit change using repeated measures Poisson regression. PMVC data were obtained from police reports for a minimum of two years pre- and post-intervention (2013 to 2018). RESULTS: Speed limit reductions from 40 km/h to 30 km/h were associated with a 28% decrease in the PMVC incidence rate in the City of Toronto (IRR = 0.72, 95% CI: 0.58-0.89). A non-significant 7% decrease in PMVC incidence rates were observed on comparator streets that remained at 40 km/h speed limits (IRR = 0.93, 95% CI: 0.70-1.25). Speed limit reduction also influenced injury severity, with a significant 67% decrease in major and fatal injuries in the post intervention period on streets with speed limit reductions (IRR = 0.33, 95% CI: 0.13-0.85) compared with a 31% not statistically significant decrease in major and fatal injuries on comparator streets (IRR = 0.69, 95% CI: 0.37-1.31). The interaction term for group and pre-post comparisons was not statistically significant (p = 0.14) indicating that there was no evidence to suggest a pre-post difference in IRRs between the intervention and comparator streets. CONCLUSIONS: Declines in the rate of PMVC were observed on roads with posted speed limit reductions from 40 km/h to 30 km/h, although this effect was not statistically greater than reductions on comparator streets.

Spatial distribution of pedestrian-motor vehicle collisions before and after pedestrian countdown signal installation in Toronto, Canada.

BACKGROUND: Pedestrian countdown signals (PCS) have been installed in many cities over the last 15 years. Few studies have evaluated the effectiveness of PCS on pedestrian motor vehicle collisions (PMVC). This exploratory study compared the spatial patterns of collisions pre and post PCS installation at PCS intersections and intersections or roadways without PCS in Toronto, and examined differences by age. METHODS: PCS were installed at the majority of Toronto intersections from 2007 to 2009. Spatial patterns were compared between 4 years of police-reported PMVC prior to PCS installation to 4 years post installation at 1864 intersections. The spatial distribution of PMVC was estimated using kernel density estimates and simple point patterns examined changes in spatial patterns overall and stratified by age. Areas of higher or lower point density pre to post installation were identified. RESULTS: There were 14 911 PMVC included in the analysis. There was an overall reduction in PMVC post PCS installation at both PCS locations and non-PCS locations, with a greater reduction at non-PCS locations (22% vs 1%). There was an increase in PMVC involving adults (5%) and older adults (9%) at PCS locations after installation, with increased adult PMVC concentrated downtown, and older adult increases occurring throughout the city following no spatial pattern. There was a reduction in children's PMVC at both PCS and non-PCS locations, with greater reductions at non-PCS locations (35% vs 48%). CONCLUSIONS: Results suggest that the effects of PCS on PMVC may vary by age and location, illustrating the usefulness of exploratory spatial data analysis approaches in road safety. The age and location effects need to be understood in order to consistently improve pedestrian mobility and safety using PCS.

The built environment and active transportation safety in children and youth: a study protocol.

BACKGROUND: Active transportation, such as walking and biking, is a healthy way for children to explore their environment and develop independence. However, children can be injured while walking and biking. Many cities make changes to the built environment (e.g., traffic calming features, separated bike lanes) to keep people safe. There is some research on how effective these changes are in preventing adult pedestrians and bicyclists from getting hurt, but very little research has been done to show how safe various environments are for children and youth. Our research program will study how features of the built environment affect whether children travel (e.g., to school) using active modes, and whether certain features increase or decrease their likelihood of injury. METHODS: First, we will use a cross-sectional study design to estimate associations between objectively measured built environment and objectively measured active transportation to school among child elementary students. We will examine the associations between objectively measured built environment and child and youth pedestrian-motor vehicle collisions (MVCs) and bicyclist-MVCs. We will also use these data to determine the space-time distribution of pedestrian-MVCs and bicyclist-MVCs. Second, we will use a case-crossover design to compare the built environment characteristics of the site where child and youth bicyclists sustain emergency department reported injuries and two randomly selected sites (control sites) along the bicyclist's route before the injury occurred. Third, to identify implementation strategies for built environment change at the municipal level to encourage active transportation we will conduct: 1) an environmental scan, 2) key informant interviews, 3) focus groups, and 4) a national survey to identify facilitators and barriers for implementing built environment change in municipalities. Finally, we will develop a built environment implementation toolkit to promote active transportation and prevent child pedestrian and bicyclist injuries. DISCUSSION: This program of research will identify the built environment associated with active transportation safety and form an evidence base from which municipalities can draw information to support change. Our team's national scope will be invaluable in providing information regarding the variability in built environment characteristics and is vital to producing evidence-based recommendations that will increase safe active transportation.

How do people become plasma and platelet donors in a VNR context?

BACKGROUND: The demand for therapeutic plasma-derived products poses a challenge to blood collection agencies (BCAs). In 2014-2015, the volume of plasma sent for fractionation met 17.7% of Quebec's needs for immunoglobulins. This article aims to offer an exploration of the paths blood donors follow in order to become plasma and platelet donors (PPDs). STUDY DESIGN AND METHOD: This analysis is based on semi-structured interviews with 50 PPDs in Quebec, Canada. Our analysis focused on the occurrence of events and the presence of contextual elements identified through: (1) factual data on PPDs; and (2) what PPDs identified as being an influence on their donation experience. This information was synthesized using a typology of trajectories. RESULTS: Six typical trajectories have been distinguished, first by the presence (19/50 respondents) or absence (31/50) of blood donation as a family tradition. Of the latter 31 donors, some pointed instead to inherited family values as having a significant influence on their commitment (11/31). Donors' careers were then distinguished as having started early (34) or late (16). Sub-types then appeared with the addition of other contextual elements, motivation profiles, and circumstances under which the conversion to apheresis donation occurred. CONCLUSION: Our findings suggest the existence of diversified donor trajectories, and confirm the importance of conducting more in-depth analyses of the sequence of events occurring along PPDs career. BCAs should develop strategies carefully tailored to different potential clienteles if they wish to convert whole blood donors to apheresis donation, and also focus on recruiting and retaining young PPDs.

Whole blood and apheresis donors in Quebec, Canada: Demographic differences and motivations to donate.

This study sought to compare demographics and donation motivations among plasma/platelet donors (PPDs) and whole blood donors (WBDs), in a voluntary and non-remunerated context. Motives to donate blood and demographic characteristics were collected through questionnaires completed by 795 WBDs and 473 PPDs. Comparison of WBDs and PPDs under chi-square tests showed that 17 out of 23 motivators were statistically different according to various demographic variables. These results demonstrate the existence of specific donor profiles both for WBDs and PPDs. Agencies should develop new recruitment strategies tailored to these donors, especially if they wish to convince WBDs to convert to apheresis donation.

Building CapaCITY/É for sustainable transportation: protocol for an implementation science research program in healthy cities.

INTRODUCTION: Improving sustainable transportation options will help cities tackle growing challenges related to population health, congestion, climate change and inequity. Interventions supporting active transportation face many practical and political hurdles. Implementation science aims to understand how interventions or policies arise, how they can be translated to new contexts or scales and who benefits. Sustainable transportation interventions are complex, and existing implementation science frameworks may not be suitable. To apply and adapt implementation science for healthy cities, we have launched our mixed-methods research programme, CapaCITY/É. We aim to understand how, why and for whom sustainable transportation interventions are successful and when they are not. METHODS AND ANALYSIS: Across nine Canadian municipalities and the State of Victoria (Australia), our research will focus on two types of sustainable transportation interventions: all ages and abilities bicycle networks and motor vehicle speed management interventions. We will (1) document the implementation process and outcomes of both types of sustainable transportation interventions; (2) examine equity, health and mobility impacts of these interventions; (3) advance implementation science by developing a novel sustainable transportation implementation science framework and (4) develop tools for scaling up and scaling out sustainable transportation interventions. Training activities will develop interdisciplinary scholars and practitioners able to work at the nexus of academia and sustainable cities. ETHICS AND DISSEMINATION: This study received approval from the Simon Fraser University Office of Ethics Research (H22-03469). A Knowledge Mobilization Hub will coordinate dissemination of findings via a website; presentations to academic, community organisations and practitioner audiences; and through peer-reviewed articles.

An Overview of How the Built Environment Relates to Children's Health.

PURPOSE OF REVIEW: Explore the varied pathways between the built environment and children's health. The review begins by describing how the built environment and transport infrastructure relate to conditions that lead to health outcomes. The review examines emissions, noise, and traffic dangers in relation to children's physical, mental, and social health. RECENT FINDINGS: Evidence is increasing for walkable neighborhoods and health-related behavior such as physical activity. However, diverse land uses (often supporting walkability) were also found to increase traffic injuries. Cognitive impacts of motorways on children at schools were found. Finally, the relationships between social activities and built environment are beginning. The built environment's influence on various physical health outcomes is increasingly clear and is often through a transport pathway. However, the links with mental and social health are less developed, though recent findings show significant results. Having accessible child-relevant destinations is an important consideration for children's health.

WalkRollMap.org: Crowdsourcing barriers to mobility.

Walking is a simple way to improve health through physical activity. Yet many people experience barriers to walking from a variety of physical, social, and psychological factors that impact their mobility. A challenge for managing and studying pedestrian environments is that barriers often occur at local scales (e.g., sidewalk features), yet such fine scale data on pedestrian facilities and experiences are often lacking or out of date. In response, our team developed WalkRollMap.org an online mapping tool that empowers communities by providing them with tools for crowdsourcing their own open data source. In this manuscript we highlight key functions of the tool, discuss initial approaches to community outreach, and share trends in reporting from the first nine months of operation. As of July 27, 2022, there have been 897 reports, of which 53% served to identify hazards, 34% missing amenities, and 14% incidents. The most frequently reported issues were related to sidewalks (15%), driver behavior (19%), and marked crosswalks (7%). The most common suggested amenities were sidewalks, marked crosswalks, connections (i.e., pathways between streets), and curb cuts. The most common types of incidents all included conflicts with vehicles. Data compiled through WalkRollMap.org offer unique potential for local and timely information on microscale barriers to mobility and are available for use by anyone as data are open and downloadable.

Regional variation in the modeling of donation frequency: the case of Héma-Québec, Canada.

BACKGROUND: Many studies on factors that can affect the frequency of blood donation have shown the influence of several individual characteristics. However, few studies have analyzed regional variations in blood donation frequency. The objective of this article is to verify to what extent individual and geographic variables influence blood donation in the Province of Québec, Canada. STUDY DESIGN AND METHODS: This article used a database provided by Héma-Québec (the organization in charge of blood collection in Québec), which included 426,247 donors, who made 1.4 million donations over a period of 5 years. Using the donors' residential postal codes and those of the blood collection sites, we created two geographic variables: the distance between the donor's place of residence and his or her collection site and each donor's region of residence. We subsequently modeled the frequency of blood donation and the different donor categories (based on the number of blood donations) using both a negative binomial regression model and an ordinal logistic regression model. RESULTS: The results indicate that, once the individual characteristics have been taken into account, the geographic variables, including proximity to the collection site, have a significant impact on the frequency of blood donation. Likewise, according to the results of the negative binomial model, among the 17 regions in the Province of Québec, there are five regions where blood donation incidence rate ratios (IRRs) are very high, that is, Abitibi-Témiscamingue (IRR, 1.77; 95% confidence interval [CI], 1.61-1.95); Bas-Saint-Laurent (IRR, 1.75; 95% CI, 1.59-1.93); Saguenay-Lac-Saint-Jean (IRR, 1.68; 95% CI, 1.53-1.84); Centre-du-Québec (IRR, 1.66; 95% CI, 1.51-1.83); and Chaudière-Appalaches (IRR, 1.62; 95% CI, 1.48-1.78). CONCLUSION: Such knowledge of the geography of blood donations makes it possible to better target certain regions when planning new blood drives, to ensure a constant blood supply.

An Examination of Child Pedestrian Rule Compliance at Crosswalks around Parks in Montreal, Canada.

This study aims to examine child pedestrian safety around parks by considering four rule-compliance measures: temporal, spatial, velocity and visual search compliance. In this regard, street crossing observations of 731 children were recorded at 17 crosswalks around four parks in Montreal, Canada. Information on child behaviors, road features, and pedestrian-vehicle interactions were gathered in three separate forms. Chi-square tests were used to highlight the individual, situational, behavioral and road environmental characteristics that are associated with pedestrian rule compliance. About half of our sampled children started crossing at the same time as the adults who accompanied them, but more rule violations were observed when the adult initiated the crossing. The child's gender did not have a significant impact on rule compliance. Several variables were positively associated with rule compliance: stopping at the curb before crossing, close parental supervision, and pedestrian countdown signals. Pedestrian-car interaction had a mixed impact on rule compliance. Overall, rule compliance among children was high for each of our indicators, but about two-thirds failed to comply with all four indicators. A few measures, such as longer crossing signals and pedestrian countdown displays at traffic lights, may help to increase rule compliance and, ultimately, provide safer access to parks.