Unintentional injury deaths associated with sport and recreation in Québec, Canada, 2006-2019.

OBJECTIVES: This study examined trends in the frequencies and rates of deaths associated with unintentional injuries in sport and recreation in Québec, Canada, for the period January 2006-December 2019. METHODS: In this descriptive retrospective study, data were extracted from the database of the Bureau du coroner du Québec. Incidence rates were calculated using participation data from the Étude des blessures subies au cours de la pratique d'activités récréatives et sportives au Québec (ÉBARS) and Canadian census population data. Poisson regression was used to investigate changes in death rates over the 14-year period by estimating incidence rate ratios. RESULTS: There were 1937 unintentional injury deaths and the population-based death rate was 1.72 per 100 000 person-years. The participation-based rate was 1.40 per 100 000 participant-years, considering the 24 matching activities in both ÉBARS' editions. Using both population-based and participation-based denominators, separate analyses consistently showed declining death rates in non-motorised navigation and cycling. Deaths related to all-terrain vehicles, snowmobiles, swimming, cycling, motorised navigation and non-motorised navigation activities accounted for 80.2% of all deaths. Drowning was documented as a cause of death in 39.3% of all fatalities. Males represented 86.8% of all deaths, with males aged 18-24 years and 65 and over having the highest rates. CONCLUSION: The death rates of unintentional injury deaths associated with non-motorised navigation and cycling declined, from January 2006 to December 2019. The characteristics and mechanisms of drowning deaths and fatalities that occurred in activities associated with higher death frequencies and rates need to be further investigated.

Head Contact and Suspected Concussion Rates in Youth Basketball: Time to Target Head Contact Penalties for Prevention.

OBJECTIVE: To compare game events, head contact (HC) rates, and suspected concussion incidence rates (IRs) in boys' and girls' youth basketball. DESIGN: Cross-sectional. SETTING: Canadian club basketball teams (U16-U18). PARTICIPANTS: Players from 24 boys' and 24 girls' Canadian club basketball teams during the 2022 season. ASSESSMENT OF RISK FACTORS: Recorded games were analyzed using Dartfish video analysis software to compare sexes. MAIN OUTCOME MEASURES: Poisson regression analyses were used to estimate HCs [direct (HC1) and indirect (HC2)], suspected concussion IRs, and IR ratios (IRRs). Game event, court location, and HC1 fouls were reported. RESULTS: Division 1 HC rates did not differ between boys (n = 238; IR = 0.50/10 player-minutes; 95% confidence interval [CI], 0.43-0.56) and girls (n = 220; IR = 0.46/10 player-minutes; 95% CI, 0.40-0.52). Division 2 boys experienced 252 HCs (IR = 0.53/10 player-minutes; 95% CI, 0.46-0.59); girls experienced 192 HCs (IR = 0.40/10 player-minutes; 95% CI, 0.35-0.46). Division 2 boys sustained higher HC1 IRs compared with Division 2 girls (IRR = 1.42; 95% CI, 1.15-1.74). Head contacts, rates did not differ between boys and girls in either Division. Suspected concussion IRs were not significantly different for boys and girls in each Division. Head contacts occurred mostly in the key for boys and girls in each Division. Despite illegality, HC1 penalization ranged from 3.9% to 19.7%. Head contact mechanisms varied across Divisions and sexes. CONCLUSIONS: Despite current safety measures, both HCs and suspected concussions occur in boys' and girls' basketball. Despite the illegality and potential danger associated with HC, only a small proportion of direct HCs were penalized and therefore targeting greater enforcement of these contacts may be a promising prevention target.

Youth Preseason Performance on the Sport Concussion Assessment Tool 5 Across Multiple Sports.

OBJECTIVE: To examine preseason Sport Concussion Assessment Tool 5 (SCAT5) performance of adolescent sport participants by environment (in-person/virtual), sex, age, concussion history, collision/noncollision sport participation, and self-reported medical diagnoses. DESIGN: Cross-sectional. SETTING: Canadian community and high-school sport settings. PARTICIPANTS: Three thousand eight hundred five adolescent (2493 male, 1275 female, and 37 did not disclose; 11- to 19-year-old) sport participants. ASSESSMENT OF RISK FACTORS: Sport Concussion Assessment Tool 5 administration method (in-person/virtual), sex (male/female/unreported), age (years), concussion history (0/1/2/3+), collision/noncollision sport participant, and self-reported medical diagnoses [attention deficit disorder or attention-deficit/hyperactivity disorder, headache/migraine, learning disability, and psychiatric disorder (ie, anxiety/depression/other)]. OUTCOME MEASURES: Preseason SCAT5 outcomes including total number of symptoms (TNS; /22), symptom severity score (SSS; /132), Standardized Assessment of Concussion (SAC; /50), and modified Balance Error Scoring System (mBESS; /30). RESULTS: Multiple multilevel linear or Poisson regression complete case analyses adjusting for clustering and robust standard errors, with ß-coefficients (95% CI) back-transformed to indicate an increase/decrease in SCAT5 subdomains when relevant for clinical interpretation. Virtual (V) performance was associated with fewer symptoms reported [TNS Difference V-IP = -1.53 (95% CI, -2.22 to -0.85)], lower SSS [-2.49 (95% CI, -4.41 to -0.58)], and fewer mBESS errors (IP) [-0.52 (95% CI, -0.77 to -0.27)] compared with in-person. For every one-year increase in age, more symptoms [TNS = 0.22 (95% CI, 0.01-0.44)], higher SSS [0.52 (95% CI, 0.01-1.06)], higher SAC [0.27 (95% CI, 0.15-0.38), and poorer balance [mBESS = -0.19 (-0.28 to -0.09)] were observed. Differences between males and females were also seen across all SCAT5 outcomes. Individuals reporting any medical diagnosis or 3+ concussion history also reported more symptoms (TNS) and higher SSS than those who did not. CONCLUSIONS: Administration environment, sex, age, concussion history, and medical diagnoses were associated with SCAT5 subdomains and are important considerations when interpreting the SCAT5 results.

Access and adherence to the most recent recommendations regarding resumption of activities after a mild traumatic brain injury.

OBJECTIVES: 1) To examine access and adherence to the Berlin (2016) recommendations for resuming physical and intellectual activities after mild traumatic brain injury (mTBI) (including an exploration of barriers and facilitators). 2) To assess post-mTBI symptoms in relation to recommendation adherence. METHOD: 73 participants who sustained a mTBI completed an online survey with questions about access and adherence to recommendations and validated measures of symptoms. RESULTS: Almost all participants had received recommendations from a health professional after their mTBI. Two thirds of recommendations reported had at least moderate correspondence with the Berlin (2016) recommendations. The vast majority of participants reported weak or partial adherence to these recommendations and only 15.7% reported complete adherence. Overall, adherence to recommendations explained a significant portion of the variance in the severity and number of unresolved post-mTBI symptoms. The most common barriers were: being in a critical period for school or work, pressure to return to work or school, screen use, and presence of symptoms. CONCLUSIONS: Sustained efforts are required to disseminate appropriate recommendations after mTBI. Clinicians should support patients in eliminating barriers to recommendation adherence, as greater adherence may facilitate recovery.

Higher Rates of Head Contacts, Body Checking, and Suspected Injuries in Ringette Than Female Ice Hockey: Time to Ring in Opportunities for Prevention.

OBJECTIVE: Ringette and female ice hockey are high participation sports in Canada. Despite policies disallowing body checking, both sports have high injury and concussion rates. This study aimed to compare physical contact (PC), head contact (HC), and suspected injury and concussion incidence rates (IRs) in female varsity ringette and ice hockey. DESIGN: Cross-sectional. SETTING: Canadian ice arenas. PARTICIPANTS: Eighteen Canadian female university ringette and ice hockey tournament/playoff games in the 2018-2019/2019-2020 seasons. ASSESSMENT OF RISK FACTORS: Game video-recordings were analyzed using Dartfish video-analysis software to compare both sports. MAIN OUTCOME MEASURES: Univariate Poisson regression analyses (adjusted for cluster by team, offset by game-minutes) were used to estimate PC, HC, and suspected injury IRs and incidence rate ratios (IRRs) to compare rates across sports. Proportions of body checks (level 4-5 trunk PC) and direct HC (HC 1 ) penalized were reported. RESULTS: Analyses of 36 team-games (n = 18 ringette, n = 18 hockey) revealed a 19% lower rate of PCs in ringette than ice hockey {IRR = 0.81 [95% confidence interval (CI), 0.73-0.90]}, but a 98% higher rate of body checking [IRR = 1.98 (95% CI, 1.27-3.09)] compared to ice hockey. Ringette had a 40% higher rate of all HC 1 s [IRR = 1.40 (95% CI, 1.00-1.96)] and a 3-fold higher rate of suspected injury [IRR = 3.11 (95% CI, 1.13-8.60)] than ice hockey. The proportion of penalized body checks and HC 1 s were low across sports. CONCLUSIONS: Body checking and HC 1 rates were significantly higher in ringette compared to ice hockey, despite rules disallowing both, and very few were penalized. These findings will inform future injury prevention research in ringette and female ice hockey.

Body checking in non-elite adolescent ice hockey leagues: it is never too late for policy change aiming to protect the health of adolescents.

OBJECTIVES: The objective of this study is to evaluate the effect of policy change disallowing body checking in adolescent ice hockey leagues (ages 15-17) on reducing rates of injury and concussion. METHODS: This is a prospective cohort study. Players 15-17 years-old were recruited from teams in non-elite divisions of play (lower 40%-70% by division of play depending on year and city of play in leagues where policy permits or prohibit body checking in Alberta and British Columbia, Canada (2015-18). A validated injury surveillance methodology supported baseline, exposure-hours and injury data collection. Any player with a suspected concussion was referred to a study physician. Primary outcomes include game-related injuries, game-related injuries (>7 days time loss), game-related concussions and game-related concussions (>10 days time loss). RESULTS: 44 teams (453 player-seasons) from non-body checking and 52 teams (674 player-seasons) from body checking leagues participated. In body checking leagues there were 213 injuries (69 concussions) and in non-body checking leagues 40 injuries (18 concussions) during games. Based on multiple multilevel mixed-effects Poisson regression analyses, policy prohibiting body checking was associated with a lower rate of injury (incidence rate ratio (IRR): 0.38 (95% CI 0.24 to 0.6)) and concussion (IRR: 0.49; 95% CI 0.26 to 0.89). This translates to an absolute rate reduction of 7.82 injuries/1000 game-hours (95% CI 2.74 to 12.9) and the prevention of 7326 injuries (95% CI 2570 to 12083) in Canada annually. CONCLUSIONS: The rate of injury was 62% lower (concussion 51% lower) in leagues not permitting body checking in non-elite 15-17 years old leagues highlighting the potential public health impact of policy prohibiting body checking in older adolescent ice hockey players.

Does Increasing the Severity of Penalties Assessed in Association With the "Zero Tolerance for Head Contact" Policy Translate to a Reduction in Head Impact Rates in Youth Ice Hockey?

OBJECTIVE: The risk of concussion is high in Canadian youth ice hockey. Aiming to reduce this burden, in 2011, Hockey Canada implemented a national "zero tolerance for head contact (HC)" policy mandating the penalization of any player HC. In 2018 to 2020, Hockey Canada further amended this HC policy including stricter enforcement of severe HCs. This study aimed to compare HC rates, head impact location, and HC enforcement prepolicy, postpolicy, and after policy amendments in elite U15 Canadian youth ice hockey. DESIGN: This is a prospective cohort study. SETTING: A collection of events with the video camera located at the highest point near center ice in public ice hockey arenas in Calgary, Alberta. PARTICIPANTS: A convenience sample of 10 AA U15 games prepolicy (2008-2009), 8 games postpolicy (2013-2014), and 10 games after policy amendments (2020-2021). INDEPENDENT VARIABLES: An analysis of 3 cohort years regarding the HC-policy implementation and amendments. MAIN OUTCOME MEASURES: Using Dartfish video-analysis software, all player contacts and HCs [direct (HC1), indirect (eg, boards, ice) (HC2)] were tagged using validated criteria. Univariate Poisson regression clustering by team-game offset by game length (minutes) was used to estimate incidence rates (IR) and incidence rate ratios (IRR) between cohorts. RESULTS: With additional rule modifications, a 30% reduction in HC1s emerged (IRR 2013-2020 = 0.70, 95% CI, 0.51-0.95). Since the HC-policy implementation, HC1s decreased by 24% (IRR 2008-2020 = 0.76, 95% CI, 0.58-0.99). The proportion of HC1s penalized was similar across cohorts (P 2008-2009 = 14.4%; P 2013-2014 = 15.5%; P 2020-2021 = 16.2%). CONCLUSIONS: The HC-policy amendments have led to decreased HC1 rates. However, referee enforcement can further boost the HC-policy effectiveness. These findings can help future referee training and potential rule modifications to increase player safety nationally.

Evaluating the Effect of Policy Prohibiting Body Checking on Physical Contacts in U15 and U18 Youth Ice Hockey Leagues.

OBJECTIVE: To compare physical contacts (PCs) and head contacts (HCs) in nonelite U15 (ages 13-14) and U18 (ages 15-17) ice hockey players in body checking (BC) and non-BC leagues. DESIGN: Cohort video analysis study. SETTING: Ice hockey arenas in Calgary, Canada. PARTICIPANTS: Players from 13 BC and 13 non-BC games at the nonelite U15 and U18 levels (n = 52 total games). ASSESSMENT OF RISK FACTORS: Games were videotaped and analyzed to compare PC variables between leagues allowing and prohibiting BC. MAIN OUTCOME MEASURES: Validated methodology for PC type (trunk PC and other types of PC with limb/stick/head), intensity (low and high intensity), and HC. Incidence rate ratios (IRRs) were estimated using Poisson regression (controlling for cluster by team game and offset by player minutes) to compare the incidence of PCs in BC and non-BC games. RESULTS: The rate of trunk PCs was lower in the non-BC leagues for both U15 (IRR = 0.50, 99% confidence interval [CI]: 0.43-0.58) and U18 (IRR = 0.56, 99% CI: 0.46-0.67) players. This was most significant for BC contacts (U15: IRR = 0.18, 99% CI: 0.11-0.29; U18: IRR = 0.16, 99% CI: 0.08-0.34), although also significant for body contacts (U15: IRR = 0.54, 99% CI: 0.46-0.64; U18: IRR = 0.58, 99% CI: 0.48-0.70), other PCs, (U15: IRR = 0.60, 99% CI: 0.45-0.78; U18: IRR = 0.71, 99% CI: 0.58-0.88), and HCs (U15: IRR = 0.40, 99% CI: 0.22-0.71; U18: IRR = 0.37, 99% CI: 0.25-0.57). CONCLUSIONS: The incidence of BC was 82% lower in the U15 and 84% lower in U18 levels not allowing BC, with lower HC and other PC rates also in non-BC leagues. These findings demonstrate high adherence with BC policy change in youth ice hockey.

Terrain park feature compliance with Québec ski area safety recommendations.

OBJECTIVES: The primary objective of this paper is to examine terrain park (TP) feature compliance with recommendations from a ski area industry guide (are TP features compliant with the guide?) and determine factors that could be associated with TP feature compliance in Québec ski areas (do factors influence TP feature compliance?), Canada. These recommendations on the design, construction and maintenance are provided by the Québec Ski Areas Association Guide. METHODS: A group of two to four trained research assistants visited seven ski areas. They used an evaluation tool to assess the compliance of 59 TP features. The evaluation tool, originally developed to assess the quality of TP features based on the guide, was validated in a previous study. Compliance was calculated by the percentage of compliant measures within a given feature. The potential influence of four factors on compliance (size of the TP, size of the feature, snow conditions and type of feature) were examined using a mixed-effects logistic regression model. RESULTS: The average TP feature compliance percentage was 93% (95% CI 88% to 99%) for boxes, 91% (95% CI 89% to 94%) for rails and 89% (95% CI 86% to 92%) for jumps. The logistic regression showed that none of the four factors examined were associated with TP feature compliance with the guide. CONCLUSION: Our results suggest that TP features are highly compliant with the guide in Québec ski areas.

Understanding youths' attitudes and practices regarding listening to music, video recording and terrain park use while skiing and snowboarding.

BACKGROUND: Skiing and snowboarding are popular activities among Canadian youth and these sports have evolved to include certain risk behaviours such as listening to music, using terrain parks, and video recording yourself or others. The objective of this study was to determine the prevalence of these risk behaviours and identify factors that are associated with the risk behaviours. METHODS: Using focus group methodology, a questionnaire was developed to capture aspects of the Theory of Planned Behaviour. A cross-sectional study was conducted where the questionnaire was administered to youth aged 13-18 during two winter seasons at two ski hills in Manitoba, Canada. RESULTS: The sample was comprised of 735 youth (mean age 14.9; 82.1% male, 83.6% snowboarding). The most common behavior was using the TP (83.1%), followed by listening to music that day (36.9%), and video recording that day (34.5%). Youth had significantly higher odds of listening to music that day if they planned to next time (OR 19.13; 95% CI: 10.62, 34.44), were skiing or snowboarding alone (OR 2.33; 95% CI: 1.10, 4.95), or thought listening to music makes skiing or snowboarding more exciting or fun or makes them feel more confident (OR 2.30; 95% CI: 1.31, 4.05). They were less likely to if they believed that music made it more difficult to hear or talk to others (OR: 0.35; 95% CI: 0.18, 0.65). Youth had significantly higher odds of using the terrain park if they believed that terrain parks were cool, challenging, or fun (OR: 5.84; 95% CI: 2.85, 11.96) or if their siblings used terrain parks (OR: 4.94; OR: 2.84, 9.85). Those who believed that terrain parks were too busy or crowded (OR: 0.31; 95% CI: 0.16, 0.62) were less likely to use them. Youth had significantly higher odds of video recording that day if they reported that they plan to video record next time (OR: 8.09, 95% CI: 4.67, 14.01) or if they were skiing or snowboarding with friends (OR: 3.65, 95% CI: 1.45, 9.18). Youth had significantly higher odds of video recording that day if they agreed that recording makes them try harder and improved their tricks (OR: 3.34, 95% CI: 1.38, 8.08) compared to those who neither agreed nor disagreed. Youth were less likely to record themselves that day if their friends did not do so (OR: 0.36; 95% CI: 0.16, 0.80). CONCLUSION: Common predictors of engaging in risk behaviours suggest that injury prevention programs may not have to be specific to each behaviour. Some strategies for injury prevention are suggested.

Does disallowing body checking in non-elite 13- to 14-year-old ice hockey leagues reduce rates of injury and concussion? A cohort study in two Canadian provinces.

OBJECTIVE: To compare rates of injury and concussion among non-elite (lowest 60% by division of play) Bantam (ages 13-14 years) ice hockey leagues that disallow body checking to non-elite Bantam leagues that allow body checking. METHODS: In this 2-year cohort study, Bantam non-elite ice hockey players were recruited from leagues where policy allowed body checking in games (Calgary/Edmonton 2014-2015, Edmonton 2015-2016) and where policy disallowed body checking (Kelowna/Vancouver 2014-2015, Calgary 2015-2016). All ice hockey game-related injuries resulting in medical attention, inability to complete a session and/or time loss from hockey were identified using valid injury surveillance methodology. Any player suspected of having concussion was referred to a study physician for diagnosis and management. RESULTS: 49 body checking (608 players) and 33 non-body checking teams (396 players) participated. There were 129 injuries (incidence rate (IR)=7.98/1000 hours) and 54 concussions (IR=3.34/1000 hours) in the body checking teams in games. After policy change, there were 31 injuries (IR=3.66/1000 hours) and 17 concussions (IR=2.01/1000 hours) in games. Policy disallowing body checking was associated with a lower rate of all injury (adjusted incidence rate ratio (IRR)=0.44; 95% CI: 0.27 to 0.74). The point estimate showed a lower rate of concussion (adjusted IRR=0.6; 95% CI: 0.31 to 1.18), but this was not statistically significant. CONCLUSION: Policy change disallowing body checking in non-elite Bantam ice hockey resulted in a 56% lower rate of injury. There is growing evidence that disallowing body checking in youth ice hockey is associated with fewer injuries.

What are the risk factors for injuries and injury prevention strategies for skiers and snowboarders in terrain parks and half-pipes? A systematic review.

OBJECTIVE: To synthesise the current evidence regarding the risk factors, the injury prevention strategies and the profile of injured skiers and snowboarders in terrain parks (TPs) and half-pipes (HPs). DESIGN: Systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. DATA SOURCES: Literature searches from six electronic databases and manual searches were performed. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Inclusion criteria were: (1) publication based on original data; (2) injuries sustained in TPs or HPs; (3) recreational skiing or snowboarding injuries; (4) observational or experimental study design with a comparison group. RESULTS: No study explored the risk factors in HPs or the prevention strategies in TPs or HPs. From the literature retrieved, there is strong evidence that skiing or snowboarding in a TP is a risk factor for head, neck, back and severe injuries. Two papers assessed the risk factors for injuries in TPs, mainly demonstrating that features promoting aerial manoeuvres or a large drop to the ground were associated with higher feature-specific injury rates. The profile of injured skiers and snowboarders in TPs described in the literature suggested some evidence of associations between factors including activity, sex, skill level, helmet use, age and TP injuries. SUMMARY/CONCLUSIONS: This systematic review demonstrates the need for studies identifying the risk factors for injuries to skiers and snowboarders and on interventions to reduce the risk of injury in TPs and HPs. Studies addressing the issue of TP design should be considered. PROSPERO REGISTRATION NUMBER: CRD42016045206.

Listening to a personal music player is associated with fewer but more serious injuries among snowboarders in a terrain park: a case-control study.

BACKGROUND: Some snowboarders listen to music on a personal music player and the objective was to determine if listening to music was associated with injury in a terrain park. METHODS: A case-control study was conducted at a terrain park in Alberta, Canada during the 2008-2009 and 2009-2010 winter seasons. Cases were snowboarders who were injured in the terrain park and presented to either the ski patrol and/or a nearby emergency department (ED). Demographic, environmental and injury characteristics were collected from standardised ski patrol Accident Report Forms, ED medical records and telephone interviews. Controls were uninjured snowboarders using the same terrain park and were interviewed as they approached the lift-line on randomly selected days and times. Multivariable logistic regression determined if listening to music was associated with the odds of snowboard injury. RESULTS: Overall, 333 injured cases and 1261 non-injured controls were enrolled; 69 (21%) cases and 425 (34%) controls were listening to music. Snowboarders listening to music had significantly lower odds of injury compared with those not listening to music (adjusted odds ratio (OR) 0.68; 95% CI 0.48 to 0.98). Snowboarders listening to music had significantly higher odds of presenting to the ED versus ski patrol only compared with those not listening to music (adjusted OR 2.09; 95% CI 1.07 to 4.05). CONCLUSIONS: While listening to music decreased the odds of any injury in the terrain park, it increased the odds of an injury resulting in ED presentation.

Evaluation of Sports Nutrition Knowledge and Recommendations Among High School Coaches.

The objectives of this study were to evaluate high school coaches' knowledge in sports nutrition and the nutritional practices they recommend to their athletes. Forty-seven high school coaches in "leanness" and "non-leanness" sports from the greater region of Quebec (women = 44.7%) completed a questionnaire on nutritional knowledge and practices. "Leanness sports" were defined as sports where leanness or/and low bodyweight were considered important (e.g., cheerleading, swimming and gymnastics), and "non-leanness sports" were defined as sports where these factors are less important (e.g., football). Participants obtained a total mean score of 68.4% for the nutrition knowledge part of the questionnaire. More specifically, less than 30% of the coaches could answer correctly some general nutrition questions regarding carbohydrates and lipids. No significant difference in nutrition knowledge was observed between coaches from "leanness" and "non-leanness" sports or between men and women. Respondents with a university education scored higher than the others (73.3% vs. 63.3%, p < .05). Coaches who participated in coaching certification also obtained better results than those without a coaching certification. The most popular source of information about nutrition used by coaches was the Internet at 55%. The two most popular nutrition practices that coaches recommended to improve athlete performance were hydration and consumption of protein-rich foods. Recommendation for nutritional supplements use was extremely rare and was suggested only by football coaches, a nonleanness sport. Findings from this study indicate that coaches need sports nutrition education and specific training.

Feature-specific terrain park-injury rates and risk factors in snowboarders: a case-control study.

BACKGROUND: Snowboarding is a popular albeit risky sport and terrain park (TP) injuries are more severe than regular slope injuries. TPs contain man-made features that facilitate aerial manoeuvres. The objectives of this study were to determine overall and feature-specific injury rates and the potential risk factors for TP injuries. METHODS: Case-control study with exposure estimation, conducted in an Alberta TP during two ski seasons. Cases were snowboarders injured in the TP who presented to ski patrol and/or local emergency departments. Controls were uninjured snowboarders in the same TP. κ Statistics were used to measure the reliability of reported risk factor information. Injury rates were calculated and adjusted logistic regression was used to calculate the feature-specific odds of injury. RESULTS: Overall, 333 cases and 1261 controls were enrolled. Reliability of risk factor information was κ>0.60 for 21/24 variables. The overall injury rate was 0.75/1000 runs. Rates were highest for jumps and half-pipe (both 2.56/1000 runs) and lowest for rails (0.43/1000 runs) and quarter-pipes (0.24/1000 runs). Compared with rails, there were increased odds of injury for half-pipe (OR 9.63; 95% CI 4.80 to 19.32), jumps (OR 4.29; 95% CI 2.72 to 6.76), mushroom (OR 2.30; 95% CI 1.20 to 4.41) and kickers (OR 1.99; 95% CI 1.27 to 3.12). CONCLUSIONS: Higher feature-specific injury rates and increased odds of injury were associated with features that promote aerial manoeuvres or a large drop to the ground. Further research is required to determine ways to increase snowboarder safety in the TP.

Winner for Life: A three-year study of student-athletes' life skills development in a training programme for coaches and teachers.

Growing numbers of researchers have investigated how training programmes influence coaches' and teachers' ability to promote life skills development, and concurrently, athlete-related outcomes. This study aimed to examine high school student-athletes' development of life skills through a three-year programme called Winner for Life (Gagnant pour la vie). Delivered online to high school coaches and teachers, the programme targeted five life skills: (a) Goal Setting and Concentration (Year 1), (b) Healthy Eating Habits and Safety Behaviours (Year 2), and Physical and Mental Recovery (Year 3). In all, 148 student-athletes participated in the programme and completed questionnaires at five time points to assess life skills development. A general linear repeated measures model was used to assess changes over time. Missing data were handled using multiple imputations. Student-athletes reported higher scores on Goal Setting subscale at time 2 (vs. time 1) and time 3 (vs. time 2) and on Social Recovery subscale at time 2 (vs. time 1). They also reported lower scores on Sleep Quality subscale at time 3 (vs. time 2) and time 5 (vs. time 4). Additionally, a significant interaction was observed between student-athletes' age (mean = 13.5 years) at study start, and improvements on certain life skills subscales over time. Overall, the fact that student-athletes did not improve on all life skills could be explained by the COVID-19 pandemic lockdowns, which limited the programme's influence from time 3. Results should be considered in light of limitations regarding gender distribution and ceiling effects on student-athletes' scores. Recommendations to improve future life skills programmes are discussed, such as involving parents in delivery and encouraging life skills teaching over time.

Characteristics of injuries sustained by snowboarders in a terrain park.

OBJECTIVE: To determine injured body regions and injury type resulting from snowboarding on aerial and nonaerial terrain park features and the accuracy of ski patrol assessments compared with physician diagnoses. DESIGN: Case series study. SETTING: An Alberta terrain park during the 2008-2009 and 2009-2010 seasons. PATIENTS: There were 333 snowboarders injured on features (379 injuries). ASSESSMENT OF RISK FACTORS: Aerial or nonaerial terrain park feature used at injury, injured body region, injury type, and additional risk factors were recorded from ski patrol Accident Report Forms, emergency department medical records, and telephone interviews. MEASURES: Odds of injury to body regions and injury types on aerial versus nonaerial features were calculated using multinomial logistic regression. Accuracy of ski patrol injury assessments was examined through sensitivity, specificity, and kappa (κ) statistics. RESULTS: The wrist was the most commonly injured body region (20%), and fracture was the most common injury type (36%). Compared with the upper extremity, the odds of head/neck [odds ratio (OR), 2.58; 95% confidence interval (CI), 1.37-4.85] and trunk (OR, 3.65; 95% CI, 1.68-7.95) injuries were significantly greater on aerial features. There was no significant association between aerial versus nonaerial feature and injury type. The accuracy of ski patrol injury assessment was higher for injured body region (κ = 0.65; 95% CI, 0.54-0.75) than for injury type (κ = 0.29; 95% CI, 0.22-0.37). CONCLUSIONS: Snowboarders were significantly more likely to sustain head/neck or trunk injuries than upper extremity injuries on aerial features. Investigators should acknowledge potential misclassification when using ski patrol injury assessments.

Risk of injury associated with bodychecking experience among youth hockey players.

BACKGROUND: In a previous prospective study, the risk of concussion and all injury was more than threefold higher among Pee Wee ice hockey players (ages 11-12 years) in a league that allows bodychecking than among those in a league that does not. We examined whether two years of bodychecking experience in Pee Wee influenced the risk of concussion and other injury among players in a Bantam league (ages 13-14) compared with Bantam players introduced to bodychecking for the first time at age 13. METHODS: We conducted a prospective cohort study involving hockey players aged 13-14 years in the top 30% of divisions of play in their leagues. Sixty-eight teams from the province of Alberta (n = 995), whose players had two years of bodychecking experience in Pee Wee, and 62 teams from the province of Quebec (n = 976), whose players had no bodychecking experience in Pee Wee, participated. We estimated incidence rate ratios (IRRs) for injury and for concussion. RESULTS: There were 272 injuries (51 concussions) among the Bantam hockey players who had bodychecking experience in Pee Wee and 244 injuries (49 concussions) among those without such experience. The adjusted IRRs for game-related injuries and concussion overall between players with bodychecking experience in Pee Wee and those without it were as follows: injury overall 0.85 (95% confidence interval [CI] 0.63 to 1.16); concussion overall 0.84 (95% CI 0.48 to 1.48); and injury resulting in more than seven days of time loss (i.e., time between injury and return to play) 0.67 (95% CI 0.46 to 0.99). The unadjusted IRR for concussion resulting in more than 10 days of time loss was 0.60 (95% CI 0.26 to 1.41). INTERPRETATION: The risk of injury resulting in more than seven days of time loss from play was reduced by 33% among Bantam hockey players in a league where bodychecking was allowed two years earlier in Pee Wee compared with Bantam players introduced to bodychecking for the first time at age 13. In light of the increased risk of concussion and other injury among Pee Wee players in a league where bodychecking is permitted, policy regarding the age at which hockey players are introduced to bodychecking requires further consideration.

The association between removing and reintroducing man-made jumps in terrain parks and severe alpine skiing and snowboarding injuries.

OBJECTIVES: To explore the effect of removing and reintroducing man-made jumps in terrain parks (TPs), on the proportion of severe injuries among alpine skiers and snowboarders in Québec, Canada. DESIGN: Quasi-experimental study. METHODS: Injuries were identified via injury report forms completed by ski patrollers during seasons 2000-2001 to 2016-2017 in Québec ski areas. Severe injuries were defined based on the type of injury or ambulance evacuation. Logistic regression analysis was used to provide adjusted odds ratios (AOR) for the comparison of the time periods before jump removal (PRE) and after jump reintroduction (POST) with the jump removal interval (INT). RESULTS: Compared with INT, the proportion of severe injuries in PRE was not significantly different (AOR: 1.05; 95% CI: 0.85-1.30), but was higher in POST (AOR: 1.76; 95% CI: 1.24-2.51) for ski areas with jump removal. In ski areas without jump removal, there was no change in PRE (AOR: 0.96; 95% CI: 0.87-1.07) and increased odds of severe injuries in POST (AOR: 1.20; 95% CI: 1.07-1.35). A supplementary analysis suggested that removing jumps from TPs has contributed significantly to a reduction in the proportion of severe injuries. This protective effect appears to decline over time. CONCLUSIONS: These results do not suggest that removing jumps from TPs as an effective long-term injury prevention strategy in skiing and snowboarding. Collecting data on exposure could improve our understanding of how removing, introducing or reintroducing man-made jumps in TPs is associated with the risk of minor and severe injuries in TPs and on regular trails.

Incidence of Head Contacts, Penalties, and Player Contact Behaviors in Youth Ice Hockey: Evaluating the "Zero Tolerance for Head Contact" Policy Change.

BACKGROUND: To reduce the risk of concussion in youth ice hockey, Hockey Canada implemented a national "zero tolerance for head contact" (HC) policy in 2011. A previous cohort study revealed higher concussion rates after this implementation in players aged 11 to 14 years. However, it is unknown whether the elevated risk was due to higher HC rates or factors such as increased concussion awareness and reporting. PURPOSE: To compare the rates of primary and secondary HCs and HC policy enforcement in elite U15 ice hockey leagues (players <15 years) before (2008-2009) and after (2013-2014) the zero-tolerance policy change. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A total of 32 elite U15 games before (n2008-2009 = 16; 510 players) and after (n2013-2014 = 16; 486 players) HC policy implementation were video recorded. Videos were analyzed with validated criteria for identifying HC types (primary/direct contact by players [HC1], secondary/indirect contact via boards, glass, or ice surface [HC2]) and other player-to-player contact behavior. Referee-assessed penalties were cross-referenced with the official Hockey Canada casebook, and penalty types were displayed using proportions. Univariate Poisson regression (adjusted for cluster by team game, offset by game length [minutes]) was used to estimate HC incidence rates (IRs) and incidence rate ratios (IRRs) between cohorts. RESULTS: A total of 506 HCs were analyzed, 261 before HC policy implementation (IR, 16.6/100 team minutes) and 245 after implementation (IR, 15.5/100 team minutes). The HC1 rate (IRR, 1.05; 95% CI, 0.86-1.28) and HC2 rate (IRR, 0.74; 95% CI, 0.50-1.11) did not significantly differ before versus after implementation. Only 12.0% and 13.6% of HC1s were penalized pre- and postimplementation, respectively. Before implementation, HC1s were commonly penalized as roughing or elbowing penalties (59%), while after implementation, HC1s were penalized with the HC penalty (76%), and only 8% as roughing or elbowing. CONCLUSION: Despite implementation of the "zero tolerance for HC" policy, there was no difference in the rate of HC1s and HC2s or the proportion of HC1 penalized from before to after implementation. This research is instrumental in informing Hockey Canada's future referee training and rule enforcement modifications.