Prioritizing a research agenda on built environments and physical activity: a twin panel Delphi consensus process with researchers and knowledge users.

BACKGROUND: The growth of urban dwelling populations globally has led to rapid increases of research and policy initiatives addressing associations between the built environment and physical activity (PA). Given this rapid proliferation, it is important to identify priority areas and research questions for moving the field forward. The objective of this study was to identify and compare research priorities on the built environment and PA among researchers and knowledge users (e.g., policy makers, practitioners). METHODS: Between September 2022 and April 2023, a three-round, modified Delphi survey was conducted among two independent panels of international researchers (n = 38) and knowledge users (n = 23) to identify similarities and differences in perceived research priorities on the built environment and PA and generate twin 'top 10' lists of the most important research needs. RESULTS: From a broad range of self-identified issues, both panels ranked in common the most pressing research priorities including stronger study designs such as natural experiments, research that examines inequalities and inequities, establishing the cost effectiveness of interventions, safety and injuries related to engagement in active transportation (AT), and considerations for climate change and climate adaptation. Additional priorities identified by researchers included: implementation science, research that incorporates Indigenous perspectives, land-use policies, built environments that support active aging, and participatory research. Additional priorities identified by knowledge users included: built environments and PA among people living with disabilities and a need for national data on trip chaining, multi-modal travel, and non-work or school-related AT. CONCLUSIONS: Five common research priorities between the two groups emerged, including (1) to better understand causality, (2) interactions with the natural environment, (3) economic evaluations, (4) social disparities, and (5) preventable AT-related injuries. The findings may help set directions for future research, interdisciplinary and intersectoral collaborations, and funding opportunities.

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

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

Methodological considerations in MVC epidemiological research.

BACKGROUND: The global burden of MVC injuries and deaths among vulnerable road users, has led to the implementation of prevention programmes and policies at the local and national level. MVC epidemiological research is key to quantifying MVC burden, identifying risk factors and evaluating interventions. There are, however, several methodological considerations in MVC epidemiological research. METHODS: This manuscript collates and describes methodological considerations in MVC epidemiological research, using examples drawn from published studies, with a focus on the vulnerable road user population of children and adolescents. RESULTS: Methodological considerations in MVC epidemiological research include the availability and quality of data to measure counts and calculate event rates and challenges in evaluation related to study design, measurement and statistical analysis. Recommendations include innovative data collection (eg, naturalistic design, stepped-wedge clinical trials), combining data sources for a more comprehensive representation of collision events, and the use of machine learning/artificial intelligence for large data sets. CONCLUSIONS: MVC epidemiological research can be challenging at all levels: data capture and quality, study design, measurement and analysis. Addressing these challenges using innovative data collection and analysis methods is required.

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

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

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

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

Driver and road characteristics associated with child pedestrian injuries.

BACKGROUND: Child pedestrians make up a significant proportion of all road traffic deaths. Our primary objective was to examine the association of driver characteristics with child pedestrian injuries with a secondary objective to broadly describe the road characteristics surrounding these collisions. METHODS: We included drivers involved in child (<18 years old) pedestrian motor-vehicle collisions (PMVCs) in Calgary and Edmonton, Alberta (2010-2015). These drivers were compared with not at fault (Alberta adaptation of a Canadian culpability scoring tool) drivers involved in vehicle-only collisions. The data were analyzed with unconditional logistic regression. RESULTS: Seven hundred ninety-three drivers collided with 826 children. One quarter of child PMVC drivers were 40-54 years old (25.2%). Younger drivers, 16-24 (adjusted odds ratio [aOR] = 1.62, 95% CI: 1.27-2.09), and older drivers, ≥55 (aOR = 1.57, 95% CI: 1.24-1.99) were more likely to be involved in a child PMVC. Time of day between 06:01 - 09:00 (aOR = 1.46, 95% CI: 1.16-1.85) and 18:01 - 24:00 (aOR = 1.68, 95% CI: 1.30-2.17), no seatbelt use (aOR = 2.30, 95% CI: 1.09-4.85), having a child passenger in the vehicle (aOR = 2.15, 95% CI: 1.56-2.96), and impairment including 'had been drinking' (aOR = 7.70, 95% CI: 2.85-20.86) and 'fatigued/asleep/medical defect' (aOR = 27.15, 95% CI: 8.30-88.88) were also associated with being a driver involved in a child PMVC. CONCLUSIONS: Age, time, impairment and distraction were risk factors for being a driver involved in a child PMVC. Because child PMVC driver characteristics differ from the general driver population, driver-based interventions are a rational additional means of preventing child PMVCs.

Canadian Child Safety Report Card: a comparison of injury prevention practices across provinces.

BACKGROUND: Injury prevention report cards that raise awareness about the preventability of childhood injuries have been published by the European Child Safety Alliance and the WHO. These report cards highlight the variance in injury prevention practices around the world. Policymakers and stakeholders have identified research evidence as an important enabler to the enactment of injury legislation. In Canada, there is currently no childhood injury report card that ranks provinces on injury rates or evidence-based prevention policies. METHODS: Three key measures, with five metrics, were used to compare provinces on childhood injury prevention rates and strategies, including morbidity, mortality and policy indicators over time (2006-2012). Nine provinces were ranked on five metrics: (1) population-based hospitalisation rate/100 000; (2) per cent change in hospitalisation rate/100 000; (3) population-based mortality rate/100 000; (4) per cent change in mortality rate/100 000; (5) evidence-based policy assessment. RESULTS: Of the nine provinces analysed, British Columbia ranked highest in Canada and Saskatchewan lowest. British Columbia had a morbidity and mortality rate that was close to the Canadian average and decreased over the study period. British Columbia also had a number of injury prevention policies and legislation in place that followed best practice guidelines. Saskatchewan had a higher rate of injury hospitalisation and death; however, Saskatchewan's rate decreased over time. Saskatchewan had a number of prevention policies in place but had not enacted bicycle helmet legislation. CONCLUSIONS: Future preventative efforts should focus on harmonising policies across all provinces in Canada that reflect evidence-based best practices.

Childhood road traffic injuries in Canada - a provincial comparison of transport injury rates over time.

BACKGROUND: In Canada, road traffic injuries are the leading cause of death among children and youth ≤19. Across the country, there is variability in road traffic injury prevention policies and legislation. Our objective was to compare pediatric road traffic related injury hospitalization and death rates across Canadian provinces. METHODS: Population-based hospitalization and death rates per 100,000 were analyzed using data from the Discharge Abstract Database and provincial coroner's reports. Road traffic related injuries sustained by children and youth ≤19 years were analyzed by province and cause between 2006 and 2012. RESULTS: The overall transport-related injury morbidity rate for children in Canada was 70.91 per 100,000 population between 2006 and 2012. The Canadian population-based injury hospitalization rates from all transport-related causes significantly decreased from 85.51 to 58.77 per 100,000 (- 4.42; p < 0.01; - 5.42; - 3.41) during the study period. Saskatchewan had the highest overall transport related morbidity rate (135.69 per 100,000), and Ontario had the lowest (47.12 per 100,000). Similar trends were observed for mortality rates in Canada. CONCLUSIONS: Transport-related injuries among children and youth have significantly decreased in Canada from 2006 to 2012; however the rates vary by province and cause.

An interprovincial comparison of unintentional childhood injury rates in Canada for the period 2006-2012.

OBJECTIVES: To perform an interprovincial comparison of unintentional population-based injury hospitalization and death rates for Canadian children ages 0-19 years and compare trends between 2006 and 2012. METHODS: Annual population-based hospitalization rates per 100,000 from unintentional injuries were calculated for children/youth (< 19 years) using data from the Discharge Abstract Database between 2006 and 2012. Annual mortality rates were analyzed using provincial coronial data. The mean annual change in the rate of hospitalizations due to unintentional injuries was reported for each province. RESULTS: The average annual rate of hospital admissions for unintentional injuries was 305.10 per 100,000 population between 2006 and 2012, and this decreased by - 11.91 over time (p < 0.01, - 15.85; - 7.77). Saskatchewan had the highest average annual morbidity rate (550.76 per 100,000) from all unintentional causes, and Ontario had the lowest average annual rate (238.89 per 100,000). Saskatchewan had the highest average annual rate for all subcauses except for drowning. Ontario was the only province with an average annual injury morbidity rate that was consistently below the Canadian average. The average annual mortality rate from all unintentional injury was highest in Saskatchewan (17.51 per 100,000) and lowest in Ontario (5.99 per 100,000) when compared to Canada (7.97 per 100,000). CONCLUSION: Injury prevention policies vary considerably among provinces. Although the unintentional injury hospitalization rate is decreasing over time, some subcauses such as choking/suffocation have shown an increase in certain provinces. Evidence-based childhood injury prevention policies, such as playground equipment safety and four-sided pool fencing among others, should be standardized across Canada.

Annual Trends in Follow-Up Visits for Pediatric Concussion in Emergency Departments and Physicians' Offices.

OBJECTIVE: To assess whether children and youth with concussion receive follow-up visits in accordance with the recommended guidelines. STUDY DESIGN: We conducted a retrospective, population-based study using linked health administrative data from all concussion-related visits to emergency department and physician offices by children aged 5 through 18 years (range, 5.00-18.99) in Ontario between 2003 and 2013. We analyzed the percentage of children and youth seen for follow-up. The Mann-Kendall test for trends was used to assess a monotonic increasing trend over time in concussion follow-up visits. RESULTS: A total of 126 654 children and youth were evaluated for an index concussion visit. The number of children and youth assessed for concussion follow-up (N = 45 155) has increased significantly over time (P < .001). In 2003, 781 of 7126 patients (11.0%; 95% CI, 10.3-11.7) with an index visit for concussion had a follow-up assessment. By 2013, 6526 of 21 681 (30.1%; 95% CI, 29.5-30.7) patients received follow-up care. CONCLUSIONS: The proportion of children and youth receiving follow-up after an acute concussion has significantly increased between 2003 and 2013. Nevertheless, more than two-thirds of all patients do not seek medical follow-up or clearance as recommended by current concussion guidelines, suggesting that ongoing efforts to improve and monitor compliance with recommended guidelines by patients and physicians are important.

A population-based study of paediatric emergency department and office visits for concussions from 2003 to 2010.

BACKGROUND: There is a paucity of information regarding descriptive epidemiology of paediatric concussions over time, and few studies include both emergency department (ED) and physician office visits. OBJECTIVE: To describe trends in visits for paediatric concussions in both EDs and physician offices according to age and sex. A secondary objective was to describe the cause of concussion for children treated in EDs. METHODS: A retrospective, population-based study using linked health administrative data from all concussion-related visits to the ED or a physician office by school-age children and youth (three to 18 years of age) in Ontario between April 1, 2003 and March 3, 2011 was conducted. RESULTS: The number of children evaluated in both EDs and a physician offices increased between 2003 and 2010, and this linear trend was statistically significant (P=0.002 for ED visits and P=0.001 for office visits). The rate per 100,000 increased from 466.7 to 754.3 for boys and from 208.6 to 440.7 for girls during the study period. Falls accounted for approximately one-third of the paediatric concussions. Hockey/skating was the most common specific cause of paediatric sports-related concussions. CONCLUSIONS: The increasing use of health care services for concussions is likely related to changes in incidence over time and increased awareness of concussion as a health issue. Evidence-based prevention initiatives to help reduce the incidence of concussion are warranted, particularly in sports and recreation programs.

HISTORIQUE: On possède peu d'information sur l'épidémiologie descriptive des commotions cérébrales en pédiatrie au fil du temps, et rares sont celles qui portent à la fois sur les visites à l'urgence et au cabinet du médecin. OBJECTIF: Décrire les tendances des visites à l'urgence et au cabinet du médecin par une population d'âge pédiatrique en raison de commotions cérébrales, en fonction de l'âge et du sexe. Un objectif secondaire consistait à décrire la cause des commotions cérébrales chez les enfants traités à l'urgence. MÉTHODOLOGIE: Des chercheurs ont mené une étude rétrospective en population reliant les données administratives en matière de santé de toutes les visites d'enfants d'âge scolaire et d'adolescents (de trois à 18 ans) à l'urgence ou au cabinet du médecin en raison d'une commotion cérébrale en Ontario, entre le 1er avril 2003 et le 3 mars 2011. RÉSULTATS: Le nombre d'enfants évalués à l'urgence ou au cabinet du médecin a augmenté entre 2003 et 2010, et cette tendance linéaire était statistiquement significative (P=0,002 pour les visites à l'urgence et P=0,001 pour celles en cabinet). Pendant la période de l'étude, le taux sur 100 000 enfants est passé de 466,7 à 754,3 chez les garçons et de 208,6 à 440,7 chez les filles. Les chutes représentaient environ le tiers des commotions cérébrales en pédiatrie, tandis que le hockey ou le patin était la principale cause de commotions cérébrales liées au sport. CONCLUSIONS: L'utilisation croissante des services de santé en raison d'une commotion cérébrale est probablement liée à l'évolution de leur incidence et à une plus grande sensibilisation à leurs conséquences sur la santé. Il faudra entreprendre des initiatives de prévention fondées sur des données probantes pour contribuer à réduire l'incidence des commotions cérébrales, notamment dans le cadre des programmes sportifs et de loisirs.

Epidemiology of sports-related injuries in children and youth presenting to Canadian emergency departments from 2007-2010.

BACKGROUND: Although injuries related to sports and recreation represent a significant burden to children and youth, few studies have examined the descriptive epidemiology of sports-related injury since 2005, and some sports such as ringette have not been evaluated to date. The primary purpose of this study was to provide the descriptive epidemiology of sports-related injuries treated in emergency departments for children and youth aged 5 - 19. METHODS: A retrospective data analysis was performed using data from the Canadian Hospitals Injury Reporting and Prevention Program [CHIRPP] from fiscal years (April - March) 2007/08 to 2009/10. CHIRPP is a computerized information system designed by the Public Health Agency of Canada that collects information about injuries to people evaluated in emergency departments across 11 pediatric hospitals and 5 general hospitals in Canada. Thirteen sports or activities were analyzed (baseball, basketball, cycling, football, ice hockey, lacrosse, ringette, rugby, skiing, sledding, snowboarding, soccer, and volleyball). Descriptive statistics, including frequency by sport, age and sex, as well as the percent of concussions within each sport were calculated. RESULTS: Out of a total of 56, 691 reported sports and recreational injuries, soccer accounted for the largest proportion of injuries with 11,941 reported cases over the 3 year time period. Of these, approximately 30% were fractures. The 10 - 14 year age group reported the greatest proportion of injuries in 10 out of the 13 sports analyzed. In addition, males reported a greater number of overall injuries than females in 11 out of the 13 sports analyzed. The largest percentage of concussions was reported in ringette; these injuries accounted for 17.1% of overall injuries within this sport. CONCLUSIONS: Injury prevention programs in Canada should focus on improving evidence-based programs to reduce the burden of injuries in all sports.