Concussion Awareness Training Tool for Youth: Impact on Concussion Knowledge, Beliefs, and Reporting Intentions.

BACKGROUND: Concussion education is recommended to increase concussion knowledge, beliefs, and reporting intentions. The Concussion Awareness Training Tool for Youth (CATT-Youth) is a 40-minute e-Learning module developed for high school-aged youth. AIM: The aim of the study was to evaluate changes in concussion knowledge, beliefs, and reporting intentions in high school youth from Calgary, Canada, following completion of the CATT-Youth. METHODS: This study used a modified stepped-wedge trial design. High school classes were randomly assigned to an intervention (Ix) or delayed intervention (DIx) group. Ix group participants completed a pre-CATT survey immediately followed by the CATT-Youth, then a post-CATT survey 2 to 6 weeks later. DIx group participants completed two pre-CATT surveys 2 to 6 weeks apart, with the CATT-Youth completed immediately following the second pre-CATT, then a post-CATT survey 2 to 6 weeks later. The pre-/post-CATT survey encompassed 11 subtests evaluating concussion knowledge, beliefs, and reporting intentions. Independent mixed linear regression models were conducted to examine changes in scores for each subtest. RESULTS: Participants included 454 high school students: five Ix schools (16 classes, n = 323) and two DIx schools (six classes, n = 131). The CATT-Youth significantly increased general concussion knowledge, Ix δ = 0.546/8 (95% confidence interval [CI] = [0.243, 0.849]), DIx δ = 0.728/8 (95% CI = [0.389, 1.106]), and beliefs about capabilities, Ix δ = 2.462/28 (95% CI = [1.086, 3.838]), DIx δ = 3.219/28 (95% CI = [1.594, 4.844]) for both groups. For some subtests, improvements were noted in the DIx group only. CONCLUSION: The CATT-Youth module improved concussion knowledge and beliefs about capabilities for students in both groups. Future studies should explore the utility of the CATT-Youth in changing knowledge, beliefs, and reporting intentions in high school students.

The Impact of COVID-19 on High School Student-Athlete Experiences with Physical Activity, Mental Health, and Social Connection.

COVID-19 restrictions led to reduced levels of physical activity, increased screen usage, and declines in mental health in youth; however, in-depth understandings of the experiences of high school student-athletes have yet to be explored. To describe the experiences of the COVID-19 pandemic on student-athletes' physical activity, social connection, and mental health, 20 high school student-athletes living in Calgary, Alberta participated in semi-structured interviews, designed using phenomenography. Participants reported variations in physical activity, social connections, and mental health which were influenced by stay-at-home restrictions and weather. Access to resources, changes to routines, online classes, and social support all influenced engagement in physical activity. School and sports provided opportunities for in-person social connections, impacted by the onset of the pandemic. Participants reported their mental health was influenced by social connections, online classes, and physical activity. Findings from this study will inform the development of resources for high school student-athletes amidst COVID-19.

Child drowning on farms in Canada and associated demographic and risk factors.

OBJECTIVES: This study aimed to examine the occurrence and characteristics of child drowning deaths on farms compared with other child injury deaths on farms. METHODS: This study uses cross-sectional data from the Canadian Agricultural Injury Reporting Program for the years 1990 through 2012. Using χ2 tests and regression, it compares the occurrence of demographics and potential risk factors between drowning deaths and all other injury deaths among children (< 19 years of age) on farms. RESULTS: There were 44 drowning deaths and 306 non-drowning deaths identified. Drowning deaths were at younger age (mean age of 5.4 versus 8.8 years old), non-work-related (25% versus 79%), and less likely to occur during adult supervision (36.4% versus 53.5%). CONCLUSIONS: Drowning disproportionately affects the very young. Improving supervision of young children may prevent some farm drowning deaths, but installing effective barriers to water hazards is likely more effective.

RéSUMé: OBJECTIFS: Examiner la survenue et les caractéristiques des décès d'enfants par noyade sur les fermes comparativement aux autres décès d'enfants attribuables aux blessures sur les fermes. MéTHODE: L'étude fait appel aux données transversales de 1990 à 2012 du programme de Surveillance des blessures dans le secteur agricole au Canada. À l'aide de tests du Χ2 et d'analyses de régression, elle compare l'existence de facteurs démographiques et de facteurs de risque potentiels entre les décès par noyade et les autres décès attribuables aux blessures chez les enfants (< 19 ans) survenus sur les fermes. RéSULTATS: Quarante-quatre décès par noyade et 306 décès autres que par noyade ont été répertoriés. Les décès par noyade ont touché des enfants plus jeunes (âge moyen de 5,4 ans contre 8,8 ans), n'étaient pas liés au travail (25 % contre 79 %) et étaient moins susceptibles de se produire sous la surveillance d'un adulte (36,4 % contre 53,5 %). CONCLUSIONS: Les noyades touchent démesurément les très jeunes enfants. Une meilleure surveillance des jeunes enfants pourrait prévenir certains décès par noyade sur les fermes, mais l'installation de barrières contre les risques aquatiques est probablement plus efficace.

Fatal farm injuries to Canadian children.

Children on Canadian farms are at high risk for fatal injury. Ongoing surveillance of these deaths is required to affirm recurrent patterns of injury, and to determine whether historical approaches to prevention have resulted in declines in the occurrence of these traumatic events. We analyzed epidemiological patterns and trends in the occurrence of fatal pediatric farm injuries over 23 years. Records of deaths were obtained from the Canadian Agricultural Injury Reporting system. To contrast more recent data with injury patterns described historically, cases were compared between two time periods. An intentional consensus process was used to finalize key patterns and their clinical or social importance. 374 fatal farm injuries to children in Canada were identified over the 23 years of study; 253 in period 1 and 121 in period 2. While machinery and non-machinery causes of death varied between the two study periods, mean annual rates of fatal injury (approximately 4 per 100,000 children) remained similar. Notably emergent types of injury in recent years included those caused by all-terrain vehicles, skid steer loaders, and drownings. Observed declines in the numbers of fatal farm injuries are most likely attributable to analogous declines in the number of registered farms in Canada. Our findings call into question the effectiveness of pediatric farm safety initiatives that primarily focus on education. Second, while CAIR fatality data are maintained, surveillance of hospitalized injuries has been disbanded and the fatality records require updating. Only by doing so will such surveillance findings provide comprehensive information to inform prevention.

Agriculture-related Injuries: Discussion in Canadian Media.

Objectives: This study examined news media reporting on farm injuries in Canada for the occurrence of prevention messages and factors related to whether an event was reported in more than one article. Methods: This study used a media database maintained by the Canadian Agricultural Safety Association (CASA), which stores publicly available news media reports of agricultural injuries and fatalities in Canada. Media reports were obtained for the years 2010 through 2017. Reports were coded as whether they reported a fatal or non-fatal injury, age and gender of those affected, urban or rural media, as well as whether they involved machinery, or were in French. Logistic regression was used to determine which variables predicted an event being reported more than once, and whether a report included a prevention message. Results: The database identified 856 relevant articles. Only 6.3% of the articles included a prevention message, and 34.7% were duplicate articles. Fatal injuries were more likely to be reported in multiple articles (odds ratio: 2.44). There was also significant variation in the occurrence of multiple reports across the years of the study. Prevention messages were more likely to occur when at least one child or female victim was involved in an event. However, only year of publication remained significantly associated with the occurrence of a prevention message in multivariable regression (odds ratio: 0.85). Conclusion: Prevention messages are rare in media reporting of farm injuries and are decreasing over time. Improved reporting is needed to aid in farm injury prevention.

Implementing a junior high school-based programme to reduce sports injuries through neuromuscular training (iSPRINT): a cluster randomised controlled trial (RCT).

OBJECTIVE: To evaluate the effectiveness of a junior high school-based sports injury prevention programme to reduce injuries through neuromuscular training (NMT). METHODS: This was a cluster randomised controlled trial. Students were recruited from 12 Calgary junior high schools (2014-2017). iSPRINT is a 15 min NMT warm-up including aerobic, agility, strength and balance exercises. Following a workshop, teachers delivered a 12-week iSPRINT NMT (six schools) or a standard-of-practice warm-up (six schools) in physical education classes. The definition of all recorded injuries included injuries that resulted in participants being unable to complete a sport and recreation (S&R) session, lost time from sport and/or seek medical attention. Incidence rate ratios (IRRs) were estimated based on multiple multilevel Poisson regression analyses (adjusting for sex (considering effect modification) and previous injury, offset by S&R participation hours, and school-level and class-level random effects were examined) for intent-to-treat analyses. RESULTS: 1067 students (aged 11-16) were recruited across 12 schools (6 intervention schools (22 classes), 6 control schools (27 classes); 53.7% female, 46.3% male). The iSPRINT programme was protective of all recorded S&R injuries for girls (IRR=0.543, 95% CI 0.295 to 0.998), but not for boys (IRR=0.866, 95% CI 0.425 to 1.766). The iSPRINT programme was also protective of each of lower extremity injuries (IRR=0.357, 95% CI 0.159 to 0.799) and medical attention injuries (IRR=0.289, 95% CI 0.135 to 0.619) for girls, but not for boys (IRR=1.055, 95% CI 0.404 to 2.753 and IRR=0.639, 95% CI 0.266 to 1.532, respectively). CONCLUSION: The iSPRINT NMT warm-up was effective in preventing each of all recorded injuries, lower extremity injuries and medically treated S&R injuries in female junior high school students. TRIAL REGISTRATION NUMBER: NCT03312504.

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.

Prevalence of distracted walking with mobile technology: an observational study of Calgary and Edmonton high school students.

OBJECTIVES: Distracted walking poses a safety concern while crossing roads. A 2014 Canadian survey showed that 51% of teenagers were hit or almost hit while crossing the street, many of whom were distracted by mobile technology. An American study demonstrated that 1 in 5 high school students engaged in distracted walking; however, prevalence estimates in Canada have not been described. This study aimed to obtain a prevalence estimate of distracted walking in high school students in Calgary and Edmonton, Alberta, Canada. METHODS: Students were observed crossing the street at 20 high schools following afternoon school dismissal times during September to November 2017. Behaviours included talking on mobile phone, using earbuds, looking down at phone, and engaging in more than one of these behaviours. Also recorded were median household income of surrounding neighbourhood, outside temperature, gender, and crosswalk type. RESULTS: A total of 3553 students were observed, with 666 engaged in distracted walking (18.7%). Females engaged in distracted walking more than males (19.9% vs. 17.6%, respectively). The most prevalent behaviour was using earbuds (66.5%). Males had a lower prevalence of distracted walking compared with females. Distracted walking was more prevalent when the temperature was above 10 °C compared with less than 0 °C and less prevalent at signaled compared with non-signaled intersections. CONCLUSION: This study demonstrates that approximately 1 in 5 high school students in Calgary and Edmonton, Alberta, Canada, engage in distracted walking behaviours while crossing the street. These results may help raise awareness and inform policy to decrease risk of pedestrian injury.

Barriers and Enablers to Enacting Child and Youth Related Injury Prevention Legislation in Canada.

Injury prevention policy is crucial for the safety of Canada's children; however legislation is not adopted uniformly across the country. This study aimed to identify key barriers and enablers to enacting injury prevention legislation. Purposive snowball sampling identified individuals involved in injury prevention throughout Canada. An online survey asked respondents to identify policies that were relevant to them, and whether legislation existed in their province. Respondents rated the importance of barriers or enablers using a 5-point Likert type scale and included open-ended comments. Fifty-seven respondents identified the most common injury topics: bicycle helmets (44, 77%), cell phone-distracted driving (36, 63%), booster seats (28, 49%), ski helmets (24, 42%), and graduated driver's licensing (21, 37%). The top enablers were research/surveillance, managerial/political support and professional group consultation, with much variability between injury topics. Open-ended comments emphasized the importance of a united opinion as an enabler and barriers included costs of protective equipment and inadequate enforcement of legislation. The results highlighted the importance of strategies that include research, management and community collaboration and that injury prevention topics should be addressed individually as information may be lost if topics are considered together. Findings can inform the process of turning injury prevention evidence into action.

The right treatment at the right time in the right place: a population-based, before-and-after study of outcomes associated with implementation of an all-inclusive trauma system in a large Canadian province.

OBJECTIVE: To evaluate the implementation of an all-inclusive philosophy of trauma care in a large Canadian province. BACKGROUND: Challenges to regionalized trauma care may occur where transport distances to level I trauma centers are substantial and few level I centers exist. In 2008, we modified our predominantly regionalized model to an all-inclusive one with the hopes of increasing the role of level III trauma centers. METHODS: We conducted a population-based, before-and-after study of patient admission and transfer practices and outcomes associated with implementation of an all-inclusive provincial trauma system using multivariable Poisson and linear regression and Cox proportional hazard models. RESULTS: In total, 21,772 major trauma patients were included. Implementation of the all-inclusive model of trauma care was associated with a decline in transfers directly to level I trauma centers [risk ratio (RR) = 0.91; 95% confidence interval (CI): 0.88-0.94; P < 0.001] and an increase in transfers from level III to level I centers (RR = 1.10; 95% CI: 1.00-1.21; P = 0.04). These changes in trauma care occurred in conjunction with a 12% reduction in the hazard of mortality (hazard ratio = 0.88; 95% CI: 0.84-0.98; P = 0.003) and a decrease in mean trauma patient hospital length of stay by 1 day (95% CI: 1.02-1.11; P = 0.02) after adjustment for differences in case mix. CONCLUSIONS: In this study, introduction of an all-inclusive provincial trauma system was associated with an increased number of injured patients cared for in their local systems and improved trauma patient mortality and hospital length of stay.

The prevalence and reliability of visibility aid and other risk factor data for uninjured cyclists and pedestrians in Edmonton, Alberta, Canada.

This study was conducted to determine the prevalence and reliability of risk factors collected on uninjured cyclists-pedestrians in Edmonton, Alberta, and what characteristics predict cyclist-pedestrian visibility. At randomly selected locations from July 2004 to August 2004, two independent observers recorded cyclist-pedestrian characteristics such as age, sex, clothing color, use of reflectors, flags, helmets, and a subjective impression of visibility. Data were collected on 836 individuals; most were either walking/jogging (approximately 63%) or cycling (approximately 33%). For non-cyclists, the prevalence of bright colored clothing on the trunk ranged from 12.7 to 14.7%. Few people used any kind of reflective strips. Inter-observer agreement (Kappa) ranged from 0.37 (visibility assessment) to 0.99 (sex). For cyclists, 17-19% of headgear was brightly colored, and 13-14% was white. Approximately one-fourth had a front light; half had a rear reflector. Few cyclists used a flag and just over half used spoke reflectors. Kappa ranged from 0.35 (observer assessed speed) to 0.95 (head gear and sex). A major trunk color of orange, red, yellow or white resulted in a higher visibility rating for both cyclists and pedestrians. The results indicate a low prevalence of visibility aid use among cyclists and pedestrians, but there appears to be acceptable inter-observer reliability for most data collected. Further work is required before an overall visibility rating can be used in place of component scores.

Use of seat belts in rural Alberta: an observational analysis.

OBJECTIVE: This paper details an observational study that estimates rates for wearing seat belts in rural Alberta and compares them with rates derived from a similar study conducted in 1999. METHOD: Direct observations of drivers and front-seat passengers of 72,593 light-duty vehicles were carried out at 334 survey locations in communities with populations of fewer than 25,000, throughout northern, central and southern Alberta. In addition to seat belt use, information collected included vehicle type, gender of drivers and passengers and, at intersections controlled by a stop sign, whether or not the vehicle came to a complete stop. RESULTS: The results indicate that in 2001 in rural Alberta the estimated proportion of driver and front-seat passengers of light-duty vehicles using seat belts was 76.1%. When compared with 1999 data, this represents a 6.9% increase in seat belt wearing rates. The data was desegregated further to show differential wearing rates between drivers of different vehicle types, males and females, drivers and passengers, and between those who came to a complete stop at a stop sign and those who did not. The time of day in which data collection took place also had some influence on seat belt wearing rates. DISCUSSION: This study contributes valuable information to programs and initiatives that aim to increase the use of seat belts in rural Alberta.

Intentional and unintentional injuries across health regions in Alberta, Canada: an implication for policy.

The growing practice of including intentional injuries (suicide and interpersonal violence) under the injury control umbrella has produced some controversy. The present study was designed to determine whether or not there might be an empirical basis for this initiative from an ecological point of view by examining the associations among unintentional and intentional injuries across 17 geographically defined health regions. The study was set in the Province of Alberta, Canada, where health services were delivered to a population of 2.96 million persons in 1999 through 17 regional health authorities. The results of a principal components analysis showed that nearly all causes of injury-hospitalization loaded on a single factor. It was not possible to produce separate factors for intentional and unintentional injuries. The strong intercorrelation among all measures suggests that there is an empirical basis for the view that intentional and unintentional injuries belong under the same conceptual umbrella, at least at the ecological level.

Fatal and non-fatal machine-related injuries suffered by children in Alberta, Canada, 1990-1997.

BACKGROUND: Children raised on farms are exposed to many hazardous types of machinery. The objective of this study was to describe the magnitude of non-fatal and fatal farm machinery injuries in Alberta children and adolescents (0-17 years) for the years 1990-1997. To date, there have been no published studies of pediatric farm injuries in Western Canada. METHODS: Data were collected through the Canadian Agricultural Injury Surveillance Program (CAISP). Death certificates and hospital charts were audited to provide enhanced information about the circumstances of injuries related to farm machinery for farm persons aged 17 years and younger. RESULTS: A total of 302 farm machinery injuries were recorded for the years 1990-1997. Of these, 14 resulted in death. All-terrain vehicles (ATVs) were the most common cause of injury (n = 76), followed by tractors (n = 72), and power take-offs (n = 15). The predominant injury mechanism was entanglement (n = 69), followed by falls from machines (n = 57), and being pinned/struck by a machine (n = 49). The median length of hospital stay for injuries was 2.0 days. Males (median = 2.0 days) had significantly longer hospital stays than females (median = 1.0 days). There were significantly more injuries reported during the summer and autumn than during the winter and spring. Those injured in the autumn were significantly older (median = 13.0 years) than children injured in the spring (median = 9.0 years). Injury rates dropped significantly during the study period from 119.9/100,000 per year in 1990 to 50.7/100,000 in 1997. CONCLUSIONS: While injury rates have dropped, the number of injuries occurring to children on Alberta farms is of concern. The large number of ATV related injuries suggests that preventative strategies need to be focused in this area. Am. J. Ind. Med. 45:177-185, 2004.

Toxicological evaluation for the hazard assessment of tire crumb for use in public playgrounds.

Disposal of used tires has been a major problem in solid waste management. New uses will have to be found to consume recycled tire products. One such proposed use is as ground cover in playgrounds. However, concern has been expressed regarding exposure of children to hazardous chemicals and the environmental impact of such chemicals. We designed a comprehensive hazard assessment to evaluate and address potential human health and environmental concerns associated with the use of tire crumb in playgrounds. Human health concerns were addressed using conventional hazard analyses, mutagenicity assays, and aquatic toxicity tests of extracted tire crumb. Hazard to children appears to be minimal. Toxicity to all aquatic organisms (bacteria, invertebrates, fish, and green algae) was observed; however, this activity disappeared with aging of the tire crumb for three months in place in the playground. We conclude that the use of tire crumb in playgrounds results in minimal hazard to children and the receiving environment.

The use of bicycle helmets in a western Canadian province without legislation.

INTRODUCTION: This study examined the use of helmets in adults, adolescents, and children in a western Canadian province that has no helmet legislation. METHODS: A prospective survey of cyclists in two urban Alberta regions was completed. Cyclist demographics, helmet wearing and helmet use were recorded. RESULTS: Helmets were observed in 2,259 (55%; 99% CI: 52-57) of 4,141 cyclists; however, only 75% (CI 71, 78) were wearing the helmet properly. Patterns of use varied according to age: 75% (CI 71, 78) of children, 29% (CI 23, 34) of adolescents, and 52% (CI 49, 55) of adults wore helmets. Percentages were higher in Calgary than Edmonton (63% vs. 45%; p < 0.0001) and females wore helmets more often (64% vs. 50%; p < 0.0001). DISCUSSION: These results identify large within- and between-region variation in the use of cycling helmets in Alberta. Injury prevention planners need to use these data to adopt interventions that are focused on age groupings, gender, and place of residence.