Impact of an injury hospital admission on childhood academic performance: a Welsh population-based data linkage study.

BACKGROUND: While injuries can impact on children's educational achievements (with threats to their development and employment prospects), these risks are poorly quantified. This population-based longitudinal study investigated the impact of an injury-related hospital admission on Welsh children's academic performance. METHODS: The Secure Anonymised Information Linkage databank, 55 587 children residing in Wales from 2006 to 2016 who had an injury hospital admission (58.2% males; 16.8% born in most deprived Wales area; 80.1% one injury hospital admission) were linked to data from the Wales Electronic Cohort for Children. The primary outcome was the Core Subject Indicator reflecting educational achievement at key stages 2 (school years 3-6), 3 (school years 7-9) and 4 (school years 10-11). Covariates in models included demographic, birth, injury and school characteristics. RESULTS: Educational achievement of children was negatively associated with: pedestrian injuries (adjusted risk ratio, (95% CIs)) (0.87, (0.83 to 0.92)), cyclist (0.96, (0.94 to 0.99)), high fall (0.96, (0.94 to 0.97)), fire/flames/smoke (0.85, (0.73 to 0.99)), cutting/piercing object (0.96, (0.93 to 0.99)), intentional self-harm (0.86, (0.82 to 0.91)), minor traumatic brain injury (0.92, (0.86 to 0.99)), contusion/open wound (0.93, (0.91 to 0.95)), fracture of vertebral column (0.78, (0.64 to 0.95)), fracture of femur (0.88, (0.84 to 0.93)), internal abdomen/pelvic haemorrhage (0.82, (0.69 to 0.97)), superficial injury (0.94, (0.92 to 0.97)), young maternal age (<18 years: 0.91, (0.88 to 0.94); 19-24 years: 0.94, (0.93 to 0.96)); area based socioeconomic status (0.98, (0.97 to 0.98)); moving to a more deprived area (0.95, (0.93 to 0.97)); requiring special educational needs (0.46, (0.44 to 0.47)). Positive associations were: being female (1.04, (1.03 to 1.06)); larger pupil school sizes and maternal age 30+ years. CONCLUSION: This study highlights the importance on a child's education of preventing injuries and implementing intervention programmes that support injured children. Greater attention is needed on equity-focused educational support and social policies addressing needs of children at risk of underachievement, including those from families experiencing poverty. VIBES-JUNIOR STUDY PROTOCOL: http://dx.doi.org/10.1136/bmjopen-2018-024755.

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.

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.

Play, Learn, and Teach Outdoors-Network (PLaTO-Net): terminology, taxonomy, and ontology.

BACKGROUND: A recent dialogue in the field of play, learn, and teach outdoors (referred to as "PLaTO" hereafter) demonstrated the need for developing harmonized and consensus-based terminology, taxonomy, and ontology for PLaTO. This is important as the field evolves and diversifies in its approaches, contents, and contexts over time and in different countries, cultures, and settings. Within this paper, we report the systematic and iterative processes undertaken to achieve this objective, which has built on the creation of the global PLaTO-Network (PLaTO-Net). METHODS: This project comprised of four major methodological phases. First, a systematic scoping review was conducted to identify common terms and definitions used pertaining to PLaTO. Second, based on the results of the scoping review, a draft set of key terms, taxonomy, and ontology were developed, and shared with PLaTO members, who provided feedback via four rounds of consultation. Third, PLaTO terminology, taxonomy, and ontology were then finalized based on the feedback received from 50 international PLaTO member participants who responded to ≥ 3 rounds of the consultation survey and dialogue. Finally, efforts to share and disseminate project outcomes were made through different online platforms. RESULTS: This paper presents the final definitions and taxonomy of 31 PLaTO terms along with the PLaTO-Net ontology model. The model incorporates other relevant concepts in recognition that all the aspects of the model are interrelated and interconnected. The final terminology, taxonomy, and ontology are intended to be applicable to, and relevant for, all people encompassing various identities (e.g., age, gender, culture, ethnicity, ability). CONCLUSIONS: This project contributes to advancing PLaTO-based research and facilitating intersectoral and interdisciplinary collaboration, with the long-term goal of fostering and strengthening PLaTO's synergistic linkages with healthy living, environmental stewardship, climate action, and planetary health agendas. Notably, PLaTO terminology, taxonomy and ontology will continue to evolve, and PLaTO-Net is committed to advancing and periodically updating harmonized knowledge and understanding in the vast and interrelated areas of PLaTO.

Predictors of health-related quality of life following injury in childhood and adolescence: a pooled analysis.

BACKGROUND: Injury is a leading contributor to the global disease burden in children and places children at risk for adverse and lasting impacts on their health-related quality of life (HRQoL) and development. This study aimed to identify key predictors of HRQoL following injury in childhood and adolescence. METHODS: Data from 2259 injury survivors (<18 years when injured) were pooled from four longitudinal cohort studies (Australia, Canada, UK, USA) from the paediatric Validating Injury Burden Estimates Study (VIBES-Junior). Outcomes were the Paediatric Quality of Life Inventory (PedsQL) total, physical, psychosocial functioning scores at 1, 3-4, 6, 12, 24 months postinjury. RESULTS: Mean PedsQL total score increased with higher socioeconomic status and decreased with increasing age. It was lower for transport-related incidents, ≥1 comorbidities, intentional injuries, spinal cord injury, vertebral column fracture, moderate/severe traumatic brain injury and fracture of patella/tibia/fibula/ankle. Mean PedsQL physical score was lower for females, fracture of femur, fracture of pelvis and burns. Mean PedsQL psychosocial score was lower for asphyxiation/non-fatal submersion and muscle/tendon/dislocation injuries. CONCLUSIONS: Postinjury HRQoL was associated with survivors' socioeconomic status, intent, mechanism of injury and comorbidity status. Patterns of physical and psychosocial functioning postinjury differed according to sex and nature of injury sustained. The findings improve understanding of the long-term individual and societal impacts of injury in the early part of life and guide the prioritisation of prevention efforts, inform health and social service planning to help reduce injury burden, and help guide future Global Burden of Disease estimates.

The association of food parenting practices with adolescents' dietary behaviors differ by youth gender, but not by parent gender.

BACKGROUND: Parents affect their adolescents' dietary behaviors through food parenting practices both directly and indirectly through adolescents' cognitive factors (self-efficacy, intrinsic or extrinsic motivation). However, it is not known if mothers and fathers use of different food parenting practices similarly influences boys' and girls' dietary behaviors. This study investigated the direct and indirect associations between food parenting practices and adolescents' dietary behaviors (fruits/vegetables and sugar sweetened beverage (SSB)) and whether these associations differed by adolescents' or parents' gender. METHODS: Data were obtained from the 2014 Family Life, Activity, Sun, Health, and Eating Study. A sample of 1633 American adolescent-parent dyads (73.7% mothers; 50.4% girls) completed the self-reported tools. Models were stratified by adolescents' gender and differences by parent gender were explored as a moderator. RESULTS: Differences did not emerge based on gender of parents. However, associations between food parenting practices and adolescents' dietary behaviors differed by adolescents' gender. Direct associations between autonomy supportive food parenting practices and fruit/vegetable intake (ß = 0.18, p < .05) and intrinsic motivations and SSB consumption (ß = -0.13, p < .05) were detected only among boys. Direct associations, regardless of gender, were also found including structured food parenting practices and adolescent self-efficacy with their dietary behaviors; controlling food parenting practices with SSB intake; as well as intrinsic and extrinsic motivation with fruit/vegetable intake. Findings from the mediation analyses supported these trends with structured parenting practices displaying similar associations on boys' and girls' dietary behaviors. In contrast, controlling and autonomy supportive parenting practices have significant indirect associations on dietary behaviors through motivation for boys only. CONCLUSION: Adolescent boys and girls appear to be affected differently by food parenting practices and accounting for these differences may contribute to more effective dietary interventions.

Evaluation of the Web-Based OutsidePlay-ECE Intervention to Influence Early Childhood Educators' Attitudes and Supportive Behaviors Toward Outdoor Play: Randomized Controlled Trial.

BACKGROUND: Outdoor play is critical to children's healthy development and well-being. Early learning and childcare centers (ELCCs) are important venues for increasing children's outdoor play opportunities, and early childhood educators' (ECE) perception of outdoor play can be a major barrier to outdoor play. The OutsidePlay-ECE risk-reframing intervention is a fully automated and open access web-based intervention to reframe ECEs' perceptions of the importance of outdoor play and risk in play and to promote a change in their practice in supporting it in ELCC settings. We grounded the intervention in social cognitive theory and behavior change techniques. OBJECTIVE: The aim of this study is to evaluate the effectiveness of the OutsidePlay-ECE web-based risk-reframing intervention. METHODS: We conducted a single-blind randomized controlled trial in Canada between December 2020 and June 2021 to test the OutsidePlay-ECE risk-reframing intervention for ECEs. We recruited participants using social media and mass emails through our partner and professional networks. We invited ECEs and administrators working in an ELCC, who can speak, read, and understand English. We randomized consented participants to the intervention or control condition. The participants allocated to the intervention condition received a link to the OutsidePlay-ECE intervention. Participants allocated to the control condition read the Position Statement on Active Outdoor Play, a 4-page document on research and recommendations for action in addressing barriers to outdoor play. The primary outcome was a change in tolerance of risk in play. The secondary outcome was goal attainment. We collected data on the web via REDCap (Vanderbilt University) at baseline and 1 week and 3 months after intervention. RESULTS: A total of 563 participants completed the baseline survey, which assessed their demographics and tolerance of risk in play. They were then randomized: 281 (49.9%) to the intervention and 282 (50.1%) to the control condition. Of these, 136 (48.4%) and 220 (78%) participants completed the baseline requirements for the intervention and control conditions, respectively. At 1 week after intervention, 126 (44.8%) and 209 (74.1%) participants completed follow-up assessments, respectively, and at 3 months after intervention, 119 (42.3%) and 195 (69.1%) participants completed the assessments, respectively. Compared with participants in the control condition, participants in the intervention group had significantly higher tolerance of risk in play at 1 week (ß=.320; P=.001) and 3 months after intervention (ß=.251; P=.009). Intention-to-treat analyses replicated these findings (ß=.335; P<.001 and ß=.271; P=.004, respectively). No significant intervention effect was found for goal attainment outcomes (odds ratio 1.124, 95% CI 0.335-3.774; P=.85). CONCLUSIONS: The results of this randomized controlled trial demonstrated that the OutsidePlay-ECE intervention was effective and had a sustained effect in increasing ECEs' and administrators' tolerance of risk in play. It was not effective in increasing goal attainment. TRIAL REGISTRATION: ClinicalTrials.gov NCT04624932; https://clinicaltrials.gov/ct2/show/NCT04624932. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/31041.

Parental Autonomy Support in the Context of Parent-Child Negotiation for Children's Independent Mobility: 'I Always Feel Safer With My Parents' to 'Boom! Bust Down Those Walls!'

Autonomy - acting volitionally with a sense of choice - is a crucial right for children. Given parents' pivotal position in their child's autonomy development, we examined how parental autonomy support and children's need for autonomy were negotiated and manifested in the context of children's independent mobility - children's ability to play, walk or cycle unsupervised. We interviewed 105 Canadian children between 10 and 13-years-old and their parents (n = 135) to examine child-parents' negotiation patterns as to children's independent mobility. Four patterns emerged, varying on parental autonomy support and children's need/motivation for independent mobility: (1) child/parent dyad wants to increase independent mobility; (2) child only wants to increase independent mobility while parents do not; (3) child does not want to increase independent mobility while parents do; and (4) child/parent dyad does not want to increase independent mobility. Findings illuminate the importance of recognizing children as active and capable agents of change.

A Web-Based and In-Person Risk Reframing Intervention to Influence Mothers' Tolerance for, and Parenting Practices Associated With, Children's Outdoor Risky Play: Randomized Controlled Trial.

BACKGROUND: Outdoor risky play, such as climbing, racing, and independent exploration, is an important part of childhood and is associated with various positive physical, mental, and developmental outcomes for children. Parental attitudes and fears, particularly mothers', are a major deterrent to children's opportunities for outdoor risky play. OBJECTIVE: The aim of this study was to evaluate the efficacy of 2 versions of an intervention to reframe mothers' perceptions of risk and change parenting behaviors: a web-based intervention or an in-person workshop, compared with the control condition. METHODS: The Go Play Outside! randomized controlled trial was conducted in Canada from 2017 to 2018. Participants were recruited through social media, snowball sampling, and community notices. Mothers of children aged 6-12 years were self-assessed through eligibility questions, and those eligible and consented to participate in the study were randomized into a fully automated web-based intervention, the in-person workshop, or the control condition. The intervention was underpinned by social cognitive theory, incorporating behavior change techniques. Participants progressed through a series of self-reflection exercises and developed a goal for change. Control participants received the Position Statement on Active Outdoor Play. The primary outcome was increase in tolerance of risky play and the secondary outcome was goal attainment. Data were collected online via REDCap at baseline, 1 week, and 3 months after the intervention. Randomization was conducted using sealed envelope. Allocations were concealed to researchers at assignment and data analysis. We conducted mediation analyses to examine whether the intervention influenced elements of social cognitive theory, as hypothesized. RESULTS: A total of 451 mothers were randomized and completed baseline sociodemographic assessments: 150 in the web-based intervention, 153 in the in-person workshop, and 148 in the control condition. Among these, a total of 351 mothers completed the intervention. At 1 week after the intervention, 113, 85, and 135 mothers completed assessments for each condition, respectively, and at 3 months after the intervention, 105, 84, and 123 completed the assessments, respectively. Compared with mothers in the control condition, mothers in the web-based intervention had significantly higher tolerance of risky play at 1 week (P=.004) and 3 months after the intervention (P=.007); and mothers in the in-person workshop had significantly higher tolerance of risky play at 1 week after the intervention (P=.02). No other significant outcomes were found. None of the potential mediators were found to significantly mediate the outcomes. CONCLUSIONS: The trial demonstrates that the web-based intervention was effective in increasing mothers' tolerance for risk in play. TRIAL REGISTRATION: ClinicalTrials.gov NCT03374683; https://clinicaltrials.gov/ct2/show/NCT03374683. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s13063-018-2552-4.

The English Knee Self-Efficacy Scale is a valid and reliable measure for knee-specific self-efficacy in individuals with a sport-related knee injury in the past 5 years.

PURPOSE: To translate and cross-culturally adapt the Swedish Knee Self-Efficacy Scale (K-SES) into English and evaluate the measurement properties in a sample of individuals with previous knee injury. METHODS: Translation, cross-cultural adaptation, and evaluation followed the Beaton multi-step process and COSMIN guidelines. Participants (n = 125) aged 16-60 years with a sport-related intra-articular tibiofemoral or patellofemoral injury within the last 5 years completed the K-SES, Knee Injury and Osteoarthritis Outcome Score, Anterior Cruciate Ligament-Return to Sport After Injury Scale, Tegner Activity Level Scale, and Multi-dimensional Health Locus of Control. Confirmatory factor analysis (CFA) tested a-priori two-factor structure and model fit. Cronbach-alpha, intra-class correlation coefficient (ICC), and absolute reliability (Bland-Altman plots) were calculated. Construct validity was assessed by eight pre-defined hypotheses. A sub-group of participants (n = 42) completed the K-SES twice to assess intra-rater reliability. RESULTS: The cross-cultural adaptation generated an English K-SES with face and content validity. The original two-factor structure was rejected based on CFA and a revised solution informed by Exploratory Factor analysis resulted in an adequate fit. All construct validity hypotheses were confirmed. The K-SES showed good internal consistency [Factor (F1: α = 0.96; F2: α = 0.73)], intra-rater reliability (ICC = 0.92), and no systematic bias between repeated measurements. CONCLUSION: The English K-SES is a valid and reliable measure for knee-specific self-efficacy in individuals who have sustained a sport-related intra-articular knee injury in the previous 5 years. LEVEL OF EVIDENCE: IV.

Impact of the COVID-19 virus outbreak on movement and play behaviours of Canadian children and youth: a national survey.

BACKGROUND: Healthy childhood development is fostered through sufficient physical activity (PA; including time outdoors), limiting sedentary behaviours (SB), and adequate sleep; collectively known as movement behaviours. Though the COVID-19 virus outbreak has changed the daily lives of children and youth, it is unknown to what extent related restrictions may compromise the ability to play and meet movement behaviour recommendations. This secondary data analysis examined the immediate impacts of COVID-19 restrictions on movement and play behaviours in children and youth. METHODS: A national sample of Canadian parents (n = 1472) of children (5-11 years) or youth (12-17 years) (54% girls) completed an online survey that assessed immediate changes in child movement and play behaviours during the COVID-19 outbreak. Behaviours included PA and play, SB, and sleep. Family demographics and parental factors that may influence movement behaviours were assessed. Correlations between behaviours and demographic and parental factors were determined. For open-ended questions, word frequency distributions were reported. RESULTS: Only 4.8% (2.8% girls, 6.5% boys) of children and 0.6% (0.8% girls, 0.5% boys) of youth were meeting combined movement behaviour guidelines during COVID-19 restrictions. Children and youth had lower PA levels, less outside time, higher SB (including leisure screen time), and more sleep during the outbreak. Parental encouragement and support, parental engagement in PA, and family dog ownership were positively associated with healthy movement behaviours. Although families spent less time in PA and more time in SB, several parents reported adopting new hobbies or accessing new resources. CONCLUSIONS: This study provides evidence of immediate collateral consequences of the COVID-19 outbreak, demonstrating an adverse impact on the movement and play behaviours of Canadian children and youth. These findings can guide efforts to preserve and promote child health during the COVID-19 outbreak and crisis recovery period, and to inform strategies to mitigate potential harm during future pandemics.

Street masking: a network-based geographic mask for easily protecting geoprivacy.

BACKGROUND: Geographic masks are techniques used to protect individual privacy in published maps but are highly under-utilized in research. This leads to continual violations of individual privacy, as sensitive health records are put at risk in unmasked maps. New approaches to geographic masking are required that foster accessibility and ease of use, such that they become more widely adopted. This article describes a new geographic masking method, called street masking, that reduces the burden on users of finding supplemental population data by instead automatically retrieving OpenStreetMap data and using the road network as a basis for masking. We compare it to donut geomasking, both with and without population density taken into account, to evaluate its efficacy against geographic masks that require slightly less and slightly more supplemental data. Our analysis is performed on synthetic data in three different Canadian cities. RESULTS: Street masking performs similarly to population-based donut geomasking with regard to privacy protection, achieving comparable k-anonymity values at similar median displacement distances. As expected, distance-based donut geomasking performs worst at privacy protection. Street masking also performs very well regarding information loss, achieving far better cluster preservation and landcover agreement than population-based donut geomasking. Distance-based donut geomasking performs similarly to street masking, though at the cost of reduced privacy protection. CONCLUSION: Street masking competes with, if not out-performs population-based donut geomasking and does so without requiring any supplemental data from users. Moreover, unlike most other geographic masks, it significantly minimizes the risk of false attribution and inherently takes many geographic barriers into account. It is easily accessible for Python users and provides the foundation for interfaces to be built for non-coding users, such that privacy can be better protected in sensitive geospatial research.

Categorizing mothers' and fathers' conceptualizations of children's serious play-related injuries: "You won't grow a finger back".

BACKGROUND: There is inconsistency across child development and care literature in operationalizing serious play-related injury and also a lack of understanding of how mothers and fathers conceptualize serious play-related injury. The current study explores parents' perspectives of their 2- to 7-year-old children's serious play-related injuries in urban and rural areas of British Columbia and Québec, Canada, and provides an urban/rural and gender analysis of the results. METHODS: We conducted semistructured interviews with 41 mothers and 63 fathers from 57 families, a total of 104 participants, in urban and rural locations in British Columbia and Québec, Canada. We used a social constructionist approach to the research and reflexive thematic analysis to construct themes from participant responses and to inform the consequent categorizations of serious play-related injury. RESULTS: The results indicate four categories of parents' conceptualizations of serious play-related injury: (a) injury requiring medical intervention, (b) injury resulting in head trauma, (c) injury resulting in debilitation, and (d) broken bones. CONCLUSIONS: Child development and care advocates can use these categories to strengthen their communications with parents and to improve understanding of parents' conceptualizations of children's serious play-related injury.

Safe Kids Week: Analysis of gender bias in a national child safety campaign, 1997-2016.

Background and Purpose Child safety campaigns play an important role in disseminating injury prevention information to families. A critical discourse analysis of gender bias in child safety campaign marketing materials can offer important insights into how families are represented and the potential influence that gender bias may have on uptake of injury prevention information. Methods Our approach was informed by poststructural feminist theory, and we used critical discourse analysis to identify discourses within the poster materials. We examined the national Safe Kids Canada Safe Kids Week campaign poster material spanning twenty years (1997-2016). Specifically, we analyzed the posters' typeface, colour, images, and language to identify gender bias in relation to discourses surrounding parenting, safety, and societal perceptions of gender. Results The findings show that there is gender bias present in the Safe Kids Week poster material. The posters represent gender as binary, mothers as primary caregivers, and showcase stereotypically masculine sporting equipment among boys and stereotypically feminine equipment among girls. Interestingly, we found that the colour and typeface of the text both challenge and perpetuate the feminization of safety. Discussion It is recommended that future child safety campaigns represent changing family dynamics, include representations of children with non-traditionally gendered sporting equipment, and avoid the representation of gender as binary. This analysis contributes to the discussion of the feminization of safety in injury prevention research and challenges the ways in which gender is represented in child safety campaigns.

Comparison of risk engagement and protection survey (REPS) among mothers and fathers of children aged 6-12 years.

BACKGROUND: Parental attitudes regarding child safety and risk engagement play important roles in child injury prevention and health promotion efforts. Few studies have compared mothers' and fathers' attitudes on these topics. This study used the risk engagement and protection survey (REPS) previously validated with fathers to compare with data collected from mothers. METHODS: Multi-group confirmatory factor analysis was used with a sample of 234 mothers and 282 fathers. Eligible parents had a child 6-12 years attending a paediatric hospital for an injury-related or other reason. We tested the factor structure of the survey by examining configural, metric and scalar invariance. Following this, mothers' and fathers' mean scores on the two identified factors of child injury protection and risk engagement were compared. RESULTS: Comparing mothers' and fathers' data showed the two-factor structure of the REPS held for the mothers' data. Comparing mean scores for the two factors suggested that fathers and mothers held equivalent attitudes. For the combined sample, parent injury protection attitude scores were significantly higher for daughters versus sons. In addition, attitude scores were significantly lower for injury protection and higher for risk engagement among parents born in Canada compared with those who were not. CONCLUSIONS: The REPS allows for valid assessment of injury protection and risk engagement factors for fathers and mothers. Mothers conceptualised the two factors as distinct concepts, similar to fathers. The REPS can be used to inform parenting programme development, implementation and evaluation.

Moderating effects of family environment on overweight/obese adolescents' dietary behaviours.

BACKGROUND: The familial environment can influence adolescents' risk for obesity. However, we do not fully understand the mechanisms through which parents can influence overweight/obese adolescents' dietary behaviours, specifically whether parenting practices (e.g., rules or routines) and/or their own dietary behaviours are associated with their overweight/obese adolescent's dietary quality. OBJECTIVES: This study examined whether parenting practices and/or parental modeling of dietary quality are associated with overweight/obese adolescents' dietary quality while considering the moderating effects of parenting styles and family functioning. METHODS: Baseline data from 172 overweight/obese adolescents and one of their parents who enrolled in a lifestyle modification intervention were analyzed [mean age = 13.1 (1.8); mean BMI z-score = 2.70 (0.83)]. Parent-adolescent dyads completed three 24-hr dietary recalls online. An index of dietary quality was computed by summing the scores for different food categories assessed in the dietary recall over 3 days. Parents completed questionnaires about their family functioning, dietary parenting practices (i.e., whether child eats breakfast everyday), and styles (authoritative and permissive). Path analysis was used to model interrelationships among the variables using the Stata software version 13. RESULTS: Parental modeling of dietary quality was significantly associated with adolescent dietary quality. Additionally, parenting styles significantly moderated parental modeling, such that an authoritative parenting style in conjunction with modeling healthy eating habits was associated with better adolescent dietary quality. CONCLUSIONS: This work suggests that parental modeling of health behaviours is important; however, it is necessary to consider the broader emotional/relational context into which modeling is expressed since parenting styles moderated these effects. This study provides insight into how parenting styles may alter the effectiveness of parental modeling and highlights the need to account for parenting styles to improve the efficacy of current family-based interventions.

Risk Engagement and Protection Survey (REPS): developing and validating a survey tool on fathers' attitudes towards child injury protection and risk engagement.

INTRODUCTION: Fathers play a unique role in keeping children safe from injury yet understanding of their views and attitudes towards protecting children from injury and allowing them to engage in risks is limited. The purpose of this study was to develop and validate an instrument to measure fathers' attitudes towards these two constructs. METHODS AND FINDINGS: An instrument was developed that used prior qualitative research to inform item generation. The questions were assessed for content validity with experts, then pilot-tested with fathers. The survey was completed by 302 fathers attending hospital with their child for an injury or non-injury reason. Results of confirmatory factor analysis identified eight items relating to the protection from injury factor and six items relating to the risk engagement factor. Correlation between the two factors was low, suggesting these are two independent constructs. CONCLUSIONS: The Risk Engagement and Protection Survey offers a tool for measuring attitudes and assisting with intervention strategy development in ways that reflect fathers' views and promotes a balanced view of children's needs for safety with their needs for engaging in active, healthy risk-taking.

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.

A longitudinal study on quality of life after injury in children.

BACKGROUND: In high income countries, injuries account for 40 % of all child deaths, representing the leading cause of child mortality and a major source of morbidity. The need for studies across age groups, and use of health related quality of life measures that assess functional limitations in multiple health domains, with sampling at specific post-injury time points has been identified. The objective of this study was to describe the impact of childhood injury and recovery on health related quality of life (HRQoL) for the 12 months after injury. METHODS: In this prospective cohort study parents of children 0-16 years old attending British Columbia Children's Hospital for an injury were surveyed over 12 months post-injury. Surveys assessed HRQoL at four points: baseline (pre-injury), one month, four to six months and 12 months post injury. Generalized estimating equation models identified factors associated with changes in HRQoL over time. RESULTS: A total of 256 baseline surveys were completed. Response rates for follow-ups at one, four and twelve months were 74 % (186), 67 % (169) and 64 % (161), respectively. The mean age of participants was 7.9 years and 30 % were admitted to the hospital. At baseline, a retrospective measure of pre-injury health, the mean HRQoL score was 90.7. Mean HRQoL ratings at one, four and 12 months post injury were 77.8, 90.3 and 91.3, respectively. Both being older and being hospitalized were associated with a steeper slope to recovery. CONCLUSIONS: Although injuries are prevalent, the long term impacts of most childhood injuries are limited. Regardless of injury severity, most injured children recuperated quickly, and had regained total baseline status by four month post-injury. However, although hospitalization did not appear to impact long term psychosocial recovery, at four and 12 months post injury a greater proportion of hospitalized children continued to have depressed physical HRQoL scores. Both older and hospitalized children reported greater impact to HRQoL at one month post injury, and both had a steeper slope to recovery and were on par with their peers by four month.