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.

The effect of surface and season on playground injury rates.

OBJECTIVE: To examine the effect of season on playground surface injury rates. METHODS: Injuries were identified through student incident report forms used in school districts in Calgary (Alberta) and the surrounding area. Playground surface exposure data were estimated based on school enrollment. RESULTS: A total of 539 injuries were reported during the 2007/2008 school year. Abrasions, bruises and inflammation were the most frequently reported injuries. The head, neck or face were most commonly injured. Injury rates per 1000 student days ranged between 0.018 (rubber crumb in spring) and 0.08 (poured-in-place and natural rock in the fall). Rubber crumb surfacing, compared with natural rock, had a significantly lower rate of injury in the spring, but no other season-surface comparisons were statistically significant. CONCLUSIONS: Rates of injury were similar for natural rock, poured-in-place, and crushed rock in the fall and winter. There was some evidence of a lower rate of injury on rubber crumb surfaces in the spring.

OBJECTIF: Examiner l'effet de la saison sur le taux de blessures subies à cause des surfaces des terrains de jeux. MÉTHODOLOGIE: Les chercheurs ont recensé les blessures grâce aux formulaires d'incidents chez les élèves utilisés, dans les districts scolaires de Calgary (Alberta) et de la région avoisinante. Ils ont évalué les données d'exposition aux surfaces de jeu d'après les inscriptions à l'école. RÉSULTATS: Au total, 539 blessures ont été déclarées pendant l'année scolaire 2007­2008. La blessure la plus courante était une abrasion, une ecchymose ou une inflammation. La tête, le cou ou le visage étaient les plus touchés. Le taux de blessures sur 1 000 jours-élèves variait entre 0,018 (miettes de caoutchouc au printemps) et 0,08 (béton coulé et roche naturelle à l'automne). Par rapport à la roche naturelle, les surfaces de miettes de caoutchouc s'associaient à un taux de blessures beaucoup moins élevé au printemps, mais aucune autre comparaison des surfaces selon les saisons n'était statistiquement significative. CONCLUSIONS: Le taux de blessures était similaire pour la roche naturelle, le béton coulé et la roche concassée à l'automne et pendant l'hiver. On remarquait certaines données probantes quant à un taux moins élevé de blessures sur les surfaces de miettes de caoutchouc au printemps.

Risk Factors for Bicycling Injuries in Children and Adolescents: A Systematic Review.

CONTEXT: Child and adolescent bicycling is beneficial, but injuries occur and can be severe and costly. OBJECTIVE: To systematically review the individual and environmental factors associated with bicycling injury risk in children and adolescents. DATA SOURCES: Fourteen electronic databases were searched. STUDY SELECTION: Two authors independently assessed potentially relevant articles for eligibility. The inclusion criteria were as follows: bicyclists younger than 20 years old; examined individual and environmental characteristics of bicycling crashes; compared injured and uninjured bicyclists or bicyclists with different types or severity of injury; study designs with a predetermined comparison group; and published in English from January 1990 to May 2015. The exclusion criteria were outcomes related to helmet use, helmet legislation, or mountain biking, and comparisons of census-based injury rates. DATA EXTRACTION: Data on study design, setting, population, injury definitions, injury risk factors, and results were extracted. Risk of bias was assessed by using the Newcastle-Ottawa Scales. RESULTS: Fourteen articles were included. Lower socioeconomic status, riding on the road, riding in rural compared with urban areas, and riding on the sidewalk were associated with bicycling injury. Bicycling safety education did not protect children against future injury. Injuries related to a motor vehicle collision were more severe than other bicycling injuries. LIMITATIONS: Study heterogeneity prevented meta-analyses. Study quality was affected by inadequate definitions of study groups and self-reported data. CONCLUSIONS: Lower socioeconomic status and riding location were associated with bicycling injury and severity increased with motor vehicle collisions. The bicycling environment is a promising avenue for prevention.

Mountain bike terrain park-related injuries: an emerging cause of morbidity.

This case-control study describes the profile of bicyclists injured in mountain bike terrain parks (MBTPs) and examines risk factors for severe injury among MBTP riders. Cases were hospitalised bicyclists injured in MBTPs. Controls were bicyclists injured in MBTPs who were discharged from the emergency department. No significant differences were observed in the distribution of age and sex between cases and controls. A higher proportion of cases compared with controls suffered a head injury (22%), fracture (41%) or internal organ injury (32%). Controls suffered a higher proportion of superficial injuries (26%), sprains (10%) or wounds (16%). Upper extremity protective equipment (e.g. elbow or shoulder pads) was used more by cases than controls (23% vs. 11%, p = 0.03). Riders who self-reported cycling faster than usual had significantly higher risk of severe injury compared with others. The risk of severe injury may be reduced by encouraging bicyclists to control their speed or by modifying MBTP design to limit the opportunity to gain speed.