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BackgroundVaping prevalence rates have increased among Canadian youth. Evidence suggests that vaping poses significant health risks to children and adolescents.ObjectivesThe objectives of the study were to investigate epidemiological characteristics of acute injury/illness cases due to the inhalation of vaping aerosols among children and adolescents across Canada and to explore factors contributing to severe cases.MethodsData from the 2019 Canadian Paediatric Surveillance Program cross-sectional survey on vaping-related injury/illness were used. Analyses focused on injury/illness cases (n=71) among children and adolescents aged 0 to 17 years who presented to participating paediatricians for a harm related to the inhalation of vaping aerosols. We conducted descriptive analyses and performed logistic regression to explore associations between severe presentations requiring hospitalization or intensive care unit (ICU) admission and selected case characteristics.ResultsOf the 71 reported injury/illness cases related to inhalation of vaping aerosols, 56% of patients were male, and 68% were aged 15 to 17 years. Nicotine vaping was reported in 42% of cases, and cannabis vaping in 24%. Fifty-four per cent presented with respiratory distress, 18% with symptoms of nicotine toxicity, and 41% required hospitalization and/or admission to the ICU. Cases presenting with respiratory distress were more likely to be hospitalized/admitted to the ICU (odds ratio [OR]=5.37, 95% confidence interval [CI]:1.76 to 16.39).ConclusionsThe inhalation of vaping aerosols among children and adolescents may contribute to acute injury/illness. Clear associations between study variables and severe cases could not be established due to a small sample size. Additional research is needed to determine predictors and preventable risk factors of severe vaping-related injuries.

OBJECTIVE To determine whether high or low adiposity is associated with youth sport-related injury. DATA SOURCES Ten electronic databases were searched to identify prospective studies examining the association between adiposity [body mass index (BMI) or body fat] and a future time-loss or medical attention sport-related musculoskeletal injury or concussion in youth aged 20 years and younger. Two independent raters assessed the quality (Downs and Black criteria) and risk of bias (Joanna Briggs Institute Critical Appraisal Tool). Random-effects meta-analyses were used to calculate pooled odds ratio [95% confidence interval (CI)] of injury. MAIN RESULTS Of 11 424 potentially relevant records, 38 articles were included with 17 eligible for meta-analyses. In qualitative synthesis, no clear association was identified between adiposity and any sport injury; however, 16/22 studies identified high adiposity as a significant risk factor for lower-extremity injury. Meta-analyses revealed higher BMI in youth with any sport-related injury and lower BMI in youth who developed a bone stress injury (BSI) compared with noninjured controls. The pooled OR (95% CI) examining the association of BMI and injury risk (excluding bone injury) was 1.18 (95% CI: 1.03-1.34). A major source of bias in included articles was inconsistent adjustment for age, sex, and physical activity participation. CONCLUSIONS Level 2b evidence suggests that high BMI is associated with greater risk of youth sport injury, particularly lower-extremity injury and excluding BSI or fracture. Although pooled mean differences were low, anthropometric risk of injury seems to be dependent on type and site of injury in youth sport.

Socio-economic status (SES) is a well-established predictor of health outcomes; however, there is a dearth of evidence on the relationship between SES and off-road vehicle (ORV) injuries. In Ontario, all-terrain vehicles (ATVs) and snowmobiles present a serious risk for preventable injury. This study assessed the association between area-level material deprivation and the risk of ATV- and snowmobile-related injuries in Ontario, as well as the impact of sex and age.A population-based, repeat cross-sectional study was conducted using administrative data of ATV- and snowmobile-related emergency room visits from 2003 to 2018. Material deprivation was measured using the Ontario Marginalization Index, which assigned a score and quintile of deprivation to each dissemination area in Ontario. Age-standardized incidence rates and relative index of inequality values were calculated, stratified by quintile of deprivation, sex, age group, vehicle type, and health region.We found a significant, positive relationship between ORV-related injuries and quintile of material deprivation (RII = 1.28, 95% CI: 1.01-1.63). Rates of ATV- and snowmobile-related injuries remained stable over time. Across all age groups, sex, and rural categories, we found an inverse u-shaped relationship between rates of injuries and quintile material deprivation. Males, individuals living in rural areas, and adolescents and young adults experienced the highest rates of injuries.Despite the positive relationship between ORV-related injuries and quintiles of deprivation, the inverse u-shaped relationship suggests that this increased risk of injury is likely related to exposure to ORVs. These results contribute to an understanding of the prevalence of the injury problem at a local level in Ontario. Stable rates of injury over time suggest that current public health programs are not sufficient in reducing these injuries, and further research should determine which factors amenable to intervention are contributing to increased risk of injury.RéSUMé: OBJECTIFS: Le statut socioéconomique (SSE) est un prédicteur bien établi des résultats pour la santé, mais il existe une pénurie de preuves sur la relation entre le SSE et les blessures des véhicules hors route. En Ontario, les véhicules tout-terrain (VTT) et les motoneiges présentent un risque sérieux de blessures évitables. Cette étude a évalué l’association entre la privation matérielle au niveau de la zone et le risque de blessures liées aux VTT et aux motoneiges en Ontario, ainsi que l’impact du sexe et de l’âge. MéTHODES: Une étude transversale répétée basée sur la population a été menée à l’aide des données administratives des visites aux urgences liées aux VTT et aux motoneiges de 2003 à 2018. La privation matérielle a été mesurée à l’aide de l’Ontario Marginalization Index, qui a attribué un score et un quintile de privation à chaque aire de diffusion en Ontario. Les taux d’incidence normalisés selon l’âge et l’indice relatif des valeurs d’inégalité ont été calculés, stratifiés par quintile de privation, sexe, groupe d’âge, type de véhicule et région sanitaire. RéSULTATS: Nous avons trouvé une relation positive significative entre les blessures liées aux VTT et le quintile de privation matérielle (RII = 1,28, IC à 95% : 1,01 – 1,63). Les taux de blessures liées aux VTT et aux motoneiges sont demeurés élevés au fil du temps. Dans tous les groupes d’âge, sexe et catégories rurales, nous avons trouvé une relation en forme de U inverse entre les taux de blessures et les quintiles de privation matérielle. Les hommes, les personnes vivant dans les zones rurales, les adolescents et les jeunes adultes ont connu les taux de blessures les plus élevés. CONCLUSION: Malgré la relation positive entre les blessures liées aux VTT et les quintiles de privation, la relation en forme de U suggère que ce risque accru de blessures est probablement lié à l’exposition aux VTT. Ces résultats contribuent à une compréhension de la prévalence du problème de blessures au niveau local en Ontario. Des taux stables de blessures au fil du temps suggèrent que les programmes de santé publique actuels ne sont pas suffisants pour réduire ces blessures, et des recherches plus poussées devraient déterminer quels facteurs susceptibles d’intervenir contribuent à augmenter le risque de blessures.

The goal of this study was to determine the injury profiles of Canadian children who presented to the Emergency Department from 1990 to 2016 due to an injury caused while traveling in a form of land transportation that did not require child restraint. A case series was conducted using data from the electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP). Children who were injured while travelling on land transportation for which child restraint is not required, who presented to a Canadian Emergency Department that participates in eCHIRPP between April 1, 1990 to August 29, 2016, were included. Overall, 1856 children sustained 2139 injuries (mean age: 9.8 years (SD 4.5), 45.5% male). The majority of children were injured on a school bus (49.3%). The most commonly injured body part was the head or neck (52.6%). The most common type of injury was a superficial or open wound (33.1%), followed by traumatic brain injury (19.3%). Overall, 39.4% of injuries required no treatment in hospital. Overall, approximately 70 children presented to eCHIRPP EDs per year on a land transportation vehicle that does not require restraints. Biomechanical studies are needed to improve safety on land transportation vehicles that do not require seatbelts.

Background As public health services are modernized in Ontario, Canada, there is a need to inform the system-level roles and responsibilities of government agencies. The aim of this study was to identify how Public Health Ontario (PHO) can optimally support evidence-based planning and programming in Healthy Growth and Development (HGD) across Ontario. Methods and design A situational assessment was conducted with key informants from public health and other HGD fields. Sample Key informants were identified using purposeful snowball sampling and included public health nurses, health promoters, and medical officers of health. Analytic strategy: Twenty telephone interviews and seven focus groups were used to collect data. A thematic analysis was conducted concurrently with data collection. Results Five themes were identified: (a) Transition to the new Ontario Public Health Standards (OPHS) included experiences of adopting the new OPHS within local public health units (PHUs). (b) Collaborating and networking referred to the ability to work with community partners. (c) Data, evidence, and research described the presence of data, evidence, and research to support practice. (d) Decision making, planning, and priority setting described resources available that influenced decision making. (e) Current and emerging issues in HGD included high-priority topics. Conclusion Public health practice in HGD is complex with many challenges in data and evidence, and making programming decisions without adequate or measurable indicators. A specialized position at PHO is an opportunity to support some of these system-wide needs.

ObjectiveTo evaluate the effectiveness of a junior high school-based sports injury prevention programme to reduce injuries through neuromuscular training (NMT).MethodsThis 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.Results1067 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).ConclusionThe 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 numberNCT03312504

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.

Injuries and deaths from motor vehicle collisions are a significant public health issue. As public health researchers and practitioners, we must support the work of municipalities by advocating for effective interventions to reduce this burden. This requires an evidence-based approach; however, many interventions embedded in existing road safety policies in Canada are not supported by evidence. The objective of this work was to review the built environment (BE) interventions in road safety policies in five, urban municipalities in Canada and summarize the peer-reviewed literature to support them. A low proportion of included studies specific to the existing road safety policies in urban areas in Canada demonstrated a reduction in collisions. Further, significant variability in the level of effectiveness across interventions exists. Information specific to the effectiveness of interventions should be an integral part of the decision making process for BE change; however, more work is needed to better understand critical decision making factors.

Road traffic injury and death continue to be a concern in Canada. The built environment (BE) is a contributing factor affecting the health of road users, yet there are significant challenges to making injury-reducing BE changes. This research increases our knowledge of these challenges by investigating the opinions of injury prevention and road safety professionals working in Canada about the barriers and facilitators to BE change. Cross-referencing themes with the CFIR situated our findings within the scope of implementation science, which demonstrated how barriers and facilitators influence BE change project implementation. The prioritization of motor vehicles results in disproportionate injury and health risks for VRUs. Collaboration across sectors, with the support of champions and advocates, can facilitate sharing of resources, data, and expertise, which results in more opportunities to enact BE change. Knowledge of these barriers and facilitators, contextualized by the CFIR, makes a case for policy/decision-makers in Canada to approve BE projects that reduce risk of road traffic injury and death.

ObjectivesAn online, evidence-based resource was created to support the development of sport and recreational injury prevention programmes. The resource, called Active & Safe Central (www.activesafe.ca), provides evidence-based information across the public health approach for a number of sport and recreational activities. The objective of this project was to evaluate the perceived usefulness of Active & Safe Central as an educational tool.DesignA mixed-methods study design, guided by the RE-AIM (reach, effectiveness, adoption, implementation and maintenance) framework, was used to evaluate Active & Safe Central.SettingData were collected using an online survey, available to all users of the site, and focus groups (n=2) that took place in Vancouver and Toronto, Canada.ParticipantsSurvey respondents (n=87) were recruited online, including parents, coaches, youth and adult athletes, and teachers. Focus group participants (n=16) were key stakeholders and end users, recruited from academia, local health sectors, sport and recreational organisations, and not-for-profit injury prevention organisations.ResultsPost launch, there were 1712 users visiting the website 2306 times (sessions), with the majority representing new users, over returning users (87.5% and 12.5%, respectively). There were 6340 page visits, with the most popular pages including soccer, playgrounds and ice hockey. Active & Safe Central was reported as a credible source of evidence-based sport and recreational information and that the site would be recommended to others. Information collected from focus group participants was used to inform necessary adaptations to the online platform, including critical navigation issues, visualisations and interactivity. The major themes that emerged from focus group and survey data included increased awareness of injury prevention recommendations and that the recommendations would be used in one’s own sporting activity and/or practice.ConclusionsThe results of the evaluation suggest the tool is a useful resource for sport and recreational injury information that has significant potential to impact prevention practice.

To determine whether high or low adiposity is associated with youth sport-related injury.Ten electronic databases were searched to identify prospective studies examining the association between adiposity [body mass index (BMI) or body fat] and a future time-loss or medical attention sport-related musculoskeletal injury or concussion in youth aged 20 years and younger. Two independent raters assessed the quality (Downs and Black criteria) and risk of bias (Joanna Briggs Institute Critical Appraisal Tool). Random-effects meta-analyses were used to calculate pooled odds ratio [95% confidence interval (CI)] of injury.Of 11 424 potentially relevant records, 38 articles were included with 17 eligible for meta-analyses. In qualitative synthesis, no clear association was identified between adiposity and any sport injury; however, 16/22 studies identified high adiposity as a significant risk factor for lower-extremity injury. Meta-analyses revealed higher BMI in youth with any sport-related injury and lower BMI in youth who developed a bone stress injury (BSI) compared with noninjured controls. The pooled OR (95% CI) examining the association of BMI and injury risk (excluding bone injury) was 1.18 (95% CI: 1.03-1.34). A major source of bias in included articles was inconsistent adjustment for age, sex, and physical activity participation.Level 2b evidence suggests that high BMI is associated with greater risk of youth sport injury, particularly lower-extremity injury and excluding BSI or fracture. Although pooled mean differences were low, anthropometric risk of injury seems to be dependent on type and site of injury in youth sport.

Objective:To assess public health nutrition practice within the public health system in Ontario, Canada to identify provincial-wide needs for scientific and technical support.Design:A qualitative descriptive study was conducted to identify activities, strengths, challenges and opportunities in public health nutrition practice using semi-structured key informant interviews (n 21) and focus groups (n 10). Recorded notes were analysed concurrently with data generation using content analysis. System needs were prioritised through a survey.Setting:Public health units.Participants:Eighty-nine practitioners, managers, directors, medical officers of health, researchers and other stakeholders were purposively recruited through snowball and extreme case sampling.Results:Five themes were generated: (i) current public health nutrition practice was broad, complex, in transition and collaborative; (ii) data/evidence/research relevant to public health needs were insufficiently available and accessible; (iii) the amount and specificity of guidance/leadership was perceived to be mismatched with strong evidence that diet is a risk factor for poor health; (iv) resources/capacity were varied but insufficient and (v) understanding of nutrition expertise in public health among colleagues, leadership and other organisations can be improved. Top ranked needs were increased understanding, visibility and prioritisation of healthy eating and food environments; improved access to data and evidence; improved collaboration and coordination; and increased alignment of activities and goals.Conclusions:Collective capacity in the public health nutrition can be improved through strategic system-wide capacity-building interventions. Research is needed to explore how improvements in data, evidence and local contexts can bridge research and practice to effectively and efficiently improve population diets and health.

Objectives Sport injury is the leading cause of hospitalization in Canadian youth and represents a high burden to the health care system. This study aims to describe the facilitators and barriers to implementation of a sport injury prevention program in junior high school physical education (known as iSPRINT), previously shown to reduce the risk of sport-related injury in youth (age, 11-15 years). Methods Focus group data were mapped onto constructs from the Consolidated Framework for Implementation Research (CFIR). Four schools that implemented iSPRINT participated in this study. Forty-seven key stakeholders (teachers, students, principals) participated in 9 semistructured focus groups and 4 interviews. The CFIR was used to guide the focus group discussions, data coding, and analysis using a qualitative content analysis approach. Results Of the 22 applicable CFIR constructs, 16 were identified in the transcripts. The most significant facilitators to successful implementation efforts included evidence strength and quality, adaptability, implementation climate, culture, and having a high level of compatibility facilitated successful implementation efforts. Barriers to implementation included intervention complexity, planning, and readiness for implementation. Constructs that acted as both a facilitator and a barrier, depending on the context, were self-efficacy, execution, and individual identification with the organization. Conclusions Participants in this study reported positive attitudes about implementing iSPRINT, citing evidence strength, adaptability, and constructs related to the organizational setting that contributed to successful implementation. Potential improvements include modifying certain program components, decreasing the number of components, and reducing the equipment required.

Background: Knowledge translation (KT) is an emerging field of practice, one in need of supports for growth, including, notably, peer mentorship.Aim: To enhance our understanding of peer me...

OBJECTIVES: The primary objectives of this work were to (1) identify the risk and/or protective factors associated with playground injuries among children less than 18 years of age and (2) identify interventions/programs/policies aimed at preventing playground-related injuries among children less than 18 years of age. Secondary objectives include a summary of the data that reflect alignment with current playground standards. METHODS: For the primary outcome, 4 databases and 12 online resources were systematically searched to include observational and experimental studies examining risk and/or protective factors or interventions associated with playground injury or outcomes related to playground injury (e.g., risky playground behaviour). Data extraction included study design, participants, outcome, exposure or intervention, data analysis, and effect estimates. The quality of evidence for all studies was assessed using the Downs and Black criteria. RESULTS: This review included studies of moderate quality, revealing a number of risk factors and effective interventions for playground injury. Risk factors included absence of handrails and guardrails on playground equipment, non-impact-absorbing surfacing, and critical fall heights. Effective interventions included modifying playground surfacing and reducing equipment height to less than 1.5 m. CONCLUSION: Equipment- and structure-based playgrounds should adhere to and maintain playground standards in order to reduce the risk of serious injury. Organizations responsible for installing and maintaining playgrounds should consider alternative play spaces that allow children to play outdoors, in a natural environment that supports healthy child development and promotes physical activity.

Objectives Approximately one-half of all children will sustain a fracture before adulthood. Understanding the factors that place a child at increased risk of fracture is necessary to inform effective injury prevention strategies. The purpose of this study was to examine the association between temperament and fracture risk in preschool-aged children. Methods Children aged 3 to 6 years who were diagnosed with a fracture were recruited from the Hospital for Sick Children Fracture Clinic. Using a retrospective case-control study design, the 148 cases were frequency-matched by age and sex to 426 controls from the TARGet Kids primary care paediatric cohort. The Childhood Behaviour Questionnaire, a 36-item caregiver response questionnaire was used to assess three of the following temperament factors: surgency (e.g., high activity level), negative affect (e.g., anger, fear, discomfort) and effortful control (e.g., attentional focusing). Results Unadjusted logistic models demonstrated no association between children with previous fracture and higher scores of surgency (unadjusted odds ratio [OR]=1.06, 95% confidence interval [CI]: 0.84, 1.34), negative affect (unadjusted OR=1.15, 95% CI: 0.93, 1.42) or effortful control (unadjusted OR=0.80, 95% CI: 0.63, 1.03). Further, models adjusted for covariates also demonstrated no significant association with surgency (1.00, 95% CI: 0.78, 1.29), negative affect (1.09, 95% CI: 0.86, 1.37) and effortful control (0.80, 95% CI: 0.61, 1.05). Conclusion None of the three main temperament types identified by the Childhood Behaviour Questionnaire were associated with an increase in fracture risk.

Introduction Unintentional injuries represent a substantial public health burden among children and adolescents, and previous evidence suggests that there are disparities in injury by socioeconomic status (SES). This paper reports on a systematic review of literature on injury rates among children and adolescents by measures of SES. Methods A systematic literature search was conducted using six electronic databases: MEDLINE, PsycINFO, CINAHL, HealthSTAR, EMBASE, and SportsDiscus. This review considered children ages 19 years and under and publications between 1997 and 2017—representing an update since the last systematic review examined this specific question. Fifty-four articles were summarized based on study and participant descriptions, outcome and exposure, statistical tests used, effect estimates, and overall significance. Results Most articles addressed risk factors across all injury mechanisms; however, some focused particularly on burns/scalds, road traffic injuries, falls/drowning cases, and playground/sports injuries. Other studies reported on specific injury types including traumatic dental injuries, traumatic brain injuries, and fractures. The studies were of moderate quality, with a median of 15.5 (95% confidence interval [CI]: 15.34 to 15.66) out of 19. Thirty-two studies found an inverse association between SES and childhood unintentional injury, three found a positive association while twenty were not significant or failed to report effect measures. Conclusion Given the variability in definition of the exposure (SES) and outcome (injury), the results of this review were mixed; however, the majority of studies supported a relationship between low SES and increased injury risk. Public health practice must consider SES, and other measures of health equity, in childhood injury prevention programming, and policy.

Background Child pedestrian-motor vehicle collisions (PMVCs) have decreased in Canada in the past 20 years. Many believe this trend is explained by the rise in automobile use for all travel. Initiatives to increase walking to school need to consider PMVC risk. Potential risk factors related to walking to school, the built environment and social factors were examined for schools with historically high child PMVC rates. Methods Child PMVCs (age 4–12 years) from 2000 to 2013 and built environment features were mapped within school attendance boundaries in the City of Toronto, Canada. Case and control schools were in the highest and lowest PMVC quartiles respectively. Observational counts of travel mode to school were conducted. Logistic regression evaluated walking to school, built environment and social risk factors for higher PMVC rates, stratified by geographic location (downtown vs. inner suburbs). Results The mean PMVC rates were 18.8/10,000/year (cases) and 2.5/10,000/year (controls). One-way street density (OR = 4.00), school crossing guard presence (OR = 3.65) and higher social disadvantage (OR = 1.37) were associated with higher PMVCs. Higher residential land use density had a protective effect (OR = 0.56). More walking was not a risk factor. While several built environment risk factors were identified for the inner suburbs; only social disadvantage was a risk factor within older urban neighbourhoods. Conclusions Several modifiable environmental risk factors were identified for child PMVCs. More walking to school was not associated with increased PMVCs after controlling for the environment. School social disadvantage was associated with higher PMVCs with differences by geographic location. These results have important implications for the design of roadways around schools.

Objectives To examine whether implementation of painted cycle lanes in Toronto, Canada is associated with a reduction in cycle-motor vehicle collisions (CMVCs). Methods A pre-post design was used to evaluate the frequency of CMVCs pre- and post-installation of 7 cycle lanes in Toronto, Canada. Study data was obtained from Toronto Police Service reports for collisions occurring between 1991 and 2010. A zero-inflated Poisson model was used to determine the effect of cycle lane installation on CMVC frequency. Results Over the study period (January 1, 1991–December 31, 2010), a total of 23,959 collisions between cyclists and motor vehicles were reported in Toronto. Of these collisions, 329 occurred on the 7 lane segments included in this analysis. There was no statistically significant change, pre to post implementation of painted cycle lanes; however, a 19% reduction in the frequency of collisions per segment-month (IRR=0.82, 95% CI: 0.65, 1.03) was observed. There were also no statistically significant differences in the frequency of collisions that resulted in minimal/minor injuries (IRR=0.84, 95% CI: 0.59, 1.20) or in major/fatal injuries (IRR=0.72, 95% CI: 0.51, 1.01). There was a statistically significant increase in collisions that resulted in no injuries (IRR=5.00, 95% CI: 1.44, 17.28). Conclusion The implementation of painted cycle lanes had a non-significant effect in reducing collisions between cyclists and motor vehicles. Cycle lanes could be considered as a means to facilitate active transportation while reducing risk for cyclists, given the conservative nature of our estimate. Further research is needed on intersection treatments, cycle tracks, and bike volumes.

BackgroundSport and recreation related injuries exert a significant cost on the healthcare system. As prevention researchers and practitioners, we have a responsibility to provide guidance towards prevention to those who participate in sport and recreation, and those that coach, treat and parent children that participate. The objective of this project was to use an integrated knowledge translation approach to develop an end user-driven digital platform that provides injury prevention information and resources across 51 sport and recreational activities.DesignWe used an integrated knowledge translation approach to scope and develop an online sport and recreational injury prevention resource. A project team was formed that included end users—coaches, parents and athletes, injury researchers and practitioners, as well as members of a digital design team. All members of the project team informed the development process, including a review of literature and existing resources, the translation of evidence and development of the platform. At all stages of development, members of the project team cocreated knowledge for the tool, including forming the research questions, the approach, feasibility and development of outcomes.ConclusionThe ‘Active & Safe Central’ (https://activesafe.ca/) platform provides web-based sport injury and prevention information. This user-friendly, web and mobile accessible platform can increase the reach, awareness and implementation of prevention programming in sport and recreational activity.

Background One of the most fundamental and formative aspects of childhood is play- which in Canada, frequently takes place on playgrounds. Previous research has shown that upgrading playground structures to comply with the Canadian Standards Association (CSA) standards, mitigates the effect of socioeconomic-status (SES) on playground injuries. Ontario government regulations require playgrounds to meet CSA standards if children in daycare use them. Objective The objective of this study was to examine the relationship between children’s falls from playground equipment and SES following compliance with CSA standards, and to examine injury trends from 2008–2015 in Ontario. Methods Population-based data from the Institute for Clinical Evaluative Sciences was used, and includes all Emergency-Department (ED) visits and hospitalizations with the ICD-10 code W09 representing falls from playground equipment. The denominator for this study was the number of children in Ontario (1–19 years) and rate per 1 00 000 was calculated from 2008–2015. SES was based on income-quintile of the child’s neighbourhood. Results There were 7,505 ED visits in 2008 vs 10 426 in 2015 (39% increase) and injury-rates demonstrated that children that live in the poorest (Quintile-1) neighbourhoods had lower playground injury rates than those in Quintile-5 (rates of 256.26, 334.3 respectively). Both income-quintiles (1 and 5) had a 45% increase over the study period and the five-to-nine age group was seen to be at highest risk of injury (average rate 551.6). Conclusion The results suggest that playground injury rates in Ontario, where most playgrounds meet the CSA standards, increase by SES status, with the wealthiest children at highest risk of injury. Differences recorded in this study may reflect differences in exposure to playgrounds (i.e., wealthier children may have more exposure to playgrounds). However, the changes to the SES/playground injury association suggests that policy changes to the built environment can modify vulnerable children’s incidence of injury.

Background Sport-specific neuromuscular training (NMT) warm-up programs have been shown to be effective in reducing injuries in youth sport but the effectiveness in school physical education (PE) is unknown. Objective To evaluate the effectiveness of iSPRINT, a NMT warm-up program implemented in junior high school (ages 11–15) PE classes in reducing sport and recreational (S and R) injury risk. Methods This is a cluster-randomized controlled trial. Participants were 1067 grade 7–9 students (53.7% female, 46.3% male) from 12 Calgary, Canada schools. iSPRINT is a 15 min NMT warm-up including aerobic, agility, strength, and balance exercises. Teachers in intervention schools (n=6) implemented the iSPRINT 12 week warm-up program in PE classes, while control schools (n=6) implemented a standard-of-practice warm-up. All teachers participated in a training workshop; only intervention school teachers participated in practical NMT components, receiving NMT video. An athletic therapist blinded to study group allocation, visited schools on a weekly basis to assess S and R injuries over 12 weeks. Injuries were those that resulted in the inability to complete a session, time loss and/or medical attention. Incidence rate ratios (IRR) were estimated based on multivariable Poisson regression analyses (adjusting for sex, clustering by class, offset by S and R participation hours). Findings The S and R injury incidence rates (IR) for all injury for the intervention and control groups respectively were1.5 and 1.8 injuries/1000 participation hours (IRR=0.73, 95% CI 0.46 to 1.16), for medical attention injuries were 0.7 and 1.3 (IRR=0.59, 95% CI 0.42 to 0.82), and 0.9 and 1.3 for lower extremity injuries (IRR=0.81, 95% CI 0.56 to 1.19). The injury incidence rate was significantly higher in females compared to males (IRR=1.59, 95% CI 1.12 to 2.22). Conclusion The iSPRINT NMT warm-up was effective in preventing medically treated S and R injuries in junior high school students. Further analysis will consider program adherence. Policy implications This research will inform safety policy considerations in junior high school PE programs.

Background Sport and recreation-related injuries have a significant cost in terms of the impact on the health care system. As prevention researchers and practitioners, we have a responsibility to provide guidance toward prevention to those who participate in sport, and those that coach, treat, and parent children that participate in sport. There are effective interventions to reduce injury in many sport and recreational activities; however, the accessibility of this information, as well as the guidance required to implement it, is often not available and accessible to the public. Objective The objective of this project was to complete a large-scale systematic review and synthesis of the literature across 51 sport and recreational activities. The evidence was used to inform the development of an end-user driven, digital platform that provides injury prevention information and resources. Methods An evidence synthesis framework was used to guide a review of reviews of 51 sport and recreational activities by 18 injury prevention trainees from across Canada. Data collection included evidence on the incidence, risk factors, interventions and implementation and evaluation of interventions to reduce the risk of injury in sport. Evidence was critically appraised, extracted, synthesized and translated into clear messaging for use in an online tool. Findings The ‘Active and Safe’ platform provides web-based sport injury and prevention information. Navigation through the tool brings the user to a sport specific content page subdivided into 4 sections: 1) sport injury overview, 2) incidence, 3) risk factors, and 4) prevention. Users are given evidence-informed, actionable prevention messaging from a personalized sporting context. Conclusion and policy implications This user friendly, web and mobile accessible tool can increase the reach, awareness and implementation of prevention programming in sport and recreational activity.

Background Public Health Ontario (PHO) is a provincial agency in Canada with a mandate to provide scientific and technical guidance to the field of public health practice. Clients include the provincial government and 36 public health units (PHUs) providing service to 14.2 million residents across over 9 00 000 square kilometres. Injury represents the leading cause of death and disability in 0–44 year olds in Canada, and PHO aims to support evidence-based injury prevention practice. Objective To complete a situational assessment of injury prevention practice across the provincial public health system to identify capacity building priorities for injury prevention knowledge and practices on a population level. The results of this study will inform a work plan in supporting effective public health practice across the system. Methods Data collection included a review of existing provincial standards and guidelines, surveillance data, evidence briefs and other knowledge exchange outputs, as well as information gathering through key informant interviews and site visits. Key informants included a cross-section of injury prevention practitioners, researchers and government staff (n=20), and site visits to 5 PHUs reflecting different population size and geographic characteristics. Site visits included interviews with front-line injury prevention practitioners, program managers, and the medical officer of health. A SWOT analysis (strengths, weaknesses, opportunities, and threats) will be used to synthesize and present the results of the situational assessment. Findings The situational assessment revealed many opportunities for collaboration and support for the PHUs. Common challenges for successful injury prevention practice included data access, evidence synthesis, and capacity to implement evidence-based practice. Conclusion and policy implications This project has significant implications for the practice of injury prevention in the province of Ontario, Canada. The results of this work will inform a work plan at PHO for injury prevention support, collaboration, and capacity building with the 36 PHUs across the province.

ObjectivesElectronic cigarettes and fluid (e-cigarettes, e-fluid) are hazardous materials that when inhaled or ingested may pose significant health risks to children and adolescents. The objective of this work was to explore the spectrum of injury related to e-cigarette exposure among Canadian children and adolescents.MethodsA one-time survey was sent to all paediatricians in Canada. Information was collected on children and adolescents who presented with e-cigarette exposure (inhalation and ingestion cases) in the previous 12 months. Questions included the number of injuries and symptoms, in addition to age, sex, treatment setting, intentional e-cigarette use, and how the products were accessed.ResultsA total of 520 surveys were completed and returned, identifying 35 cases. Symptoms related to inhalation were present in 30 cases and in 5 ingestion cases (5 unintentional, 0 intentional). For inhalation cases, most were male, ages 15 to 19 years, who sought treatment for nausea/vomiting, cough, throat irritation, or acute nicotine toxicity in an outpatient clinic/office. Most inhalation cases reported e-cigarette use 2 to 3 days/week, and e-cigarettes purchases from a mall kiosk/store. For ingestion cases, most were male, ages 1 to 4 years presenting to an emergency department with nausea/vomiting, cough, or respiratory irritation. Younger cases accessed e-fluid at home, older cases purchased in a mall kiosk/store. E-fluid flavours reported consumed were fruit, candy, and tobacco.ConclusionsE-cigarettes, recently introduced into the North American market are hazardous to children and adolescents. Given the low response rate to the survey, further investigation into the true burden of injury, as well as the risks that e-cigarettes pose, together with ways to reduce exposure, is needed.

Biodiversity of marine areas beyond the reach of conventional diving technology (>30 m) is poorly known, yet subjected to increasing stresses from expanding recreational and commercial fishing, minerals exploration and other anthropogenic influences. In part, resource managers address this by using abiotic surrogates for patterns of biodiversity in planning marine protected areas or other management measures. However, the efficacy of these surrogates varies from place to place, and is often not quantified at the scale used by MPA designers and managers. This study surveyed and classified benthic assemblages of continental shelf rocky reefs across three depth categories from 30 to 70 m, using a suspended HD camera array, which is both non-destructive and cost-effective compared to any other methods of sampling at these depths. Five distinct benthic biotopes were defined, characterised primarily by variations in abundances of sea whips, sponges, kelp, and urchins. Derived patterns of benthic assemblage structure were compared to abiotic surrogates available at the scale (local) used in MPA planning. The individual factors with most influence on the classification were recreational fishing pressure, water temperature at the bottom, and distance from nearest estuary. The best combination of abiotic surrogates had a relatively strong relationship with the benthic assemblage, explaining 42% of the variation in assemblage structure (BIOENV ρ = 0.65), however the performance of a classification based on commonly used physical surrogates was relatively poor, explaining only 22% of variation. The results underline the limitations of using abiotic variables for habitat mapping at the local scale, and the need for robust surveys to quantify patterns of biodiversity.

Background Bicycling is a popular means of recreation and transportation for children; however, it is a leading cause of recreational injury. Bicycle skill development and safety education are important methods of bicycle injury prevention. Objective To determine the effectiveness of bicycle skills training programmes in reducing bicycle-related injuries in children and youth. Methods Sixteen databases were systematically searched to include studies involving children less than 19 years of age who participated in interventions that targeted bicycle skills and safety education. Outcome measures included injury, behaviour, knowledge and attitudes. Data extraction included study characteristics, intervention and outcomes. Quality of evidence was assessed using the Downs and Black criteria. Results Twenty-five studies, including both observational (ie, case–control) and experimental (ie, randomised controlled trials) designs met the inclusion criteria. Overall, there was no statistically significant intervention effect on measures of injury. Eight of 16 studies measuring knowledge reported significant knowledge gains as a result of the intervention. Of 13 studies evaluating behavioural and attitude changes, five reported significant improvement. There was no significant difference in quality index scores between studies that showed an improvement in knowledge or behaviour (61%, 95% CI 49% to 74%) and studies that did not (57%, 95% CI 48% to 66%). Conclusions There is a paucity of high-quality research in the area of bicycle skills training programmes. Educational and skills training bicycling programmes may increase knowledge of cycling safety, but this does not seem to translate into a decrease in injury rate, or improved bicycle handling ability and attitudes.

Objectives To investigate the relationship between sport injury and body mass index in adolescents (12–19 years). Design Secondary analysis of data collected in junior and senior high school surveys in Alberta, Canada. Methods Participants (n = 4339) included students from 59 schools. All sport injury was defined as injury reported in the past one year. Medically treated injury, as any more serious sport related injury reported in the last year that required medical attention. Overweight, obese, and healthy was defined using international cut points, as the exposure. Results Multivariate logistic regression analysis controlling for clustering by school, and adjusting for potential risk factors was used. There was a 34% increased risk for all sport injury in obese adolescents compared to healthy adolescents [odds ratio (OR) = 1.34 (95% CI: 1.02–1.80)]. There was increased risk for all sport injury and medically treated injury with hours of participation, where the highest group had a 4-fold increase in risk (OR = 4.17, 95%CI: 2.77–6.30 and OR = 3.80, 95%CI: 2.54–5.69, respectively). There was also increased risk for both all sport injury and medically treated injury in Caucasians compared to non-Caucasians [OR = 1.45 (95%CI: 1.15–1.82), OR = 1.94 (95%CI: 1.59–2.37), respectively], as well as for club/team play compared to less elite play [OR = 1.87 (95%CI: 1.43–2.44) and OR = 2.12 (95%CI: 1.57–2.87), respectively]. Conclusions The risk of sustaining a sport injury in obese adolescents was greater compared to those of healthy weight. There is also a greater risk with increasing hours of play, in Caucasian adolescents, and those that play at a higher sporting level.

BackgroundPedestrian countdown signals (PCS) have been installed in many cities over the last 15 years. Few studies have evaluated the effectiveness of PCS on pedestrian motor vehicle collisions (PMVC). This exploratory study compared the spatial patterns of collisions pre and post PCS installation at PCS intersections and intersections or roadways without PCS in Toronto, and examined differences by age.MethodsPCS were installed at the majority of Toronto intersections from 2007 to 2009. Spatial patterns were compared between 4 years of police-reported PMVC prior to PCS installation to 4 years post installation at 1864 intersections. The spatial distribution of PMVC was estimated using kernel density estimates and simple point patterns examined changes in spatial patterns overall and stratified by age. Areas of higher or lower point density pre to post installation were identified.ResultsThere were 14 911 PMVC included in the analysis. There was an overall reduction in PMVC post PCS installation at both PCS locations and non-PCS locations, with a greater reduction at non-PCS locations (22% vs 1%). There was an increase in PMVC involving adults (5%) and older adults (9%) at PCS locations after installation, with increased adult PMVC concentrated downtown, and older adult increases occurring throughout the city following no spatial pattern. There was a reduction in children’s PMVC at both PCS and non-PCS locations, with greater reductions at non-PCS locations (35% vs 48%).ConclusionsResults suggest that the effects of PCS on PMVC may vary by age and location, illustrating the usefulness of exploratory spatial data analysis approaches in road safety. The age and location effects need to be understood in order to consistently improve pedestrian mobility and safety using PCS.

A growing number of researchers and trainees identify knowledge translation (KT) as their field of study or practice. Yet, KT educational and professional development opportunities and established KT networks remain relatively uncommon, making it challenging for trainees to develop the necessary skills, networks, and collaborations to optimally work in this area. The Knowledge Translation Trainee Collaborative is a trainee-initiated and trainee-led community of practice established by junior knowledge translation researchers and practitioners to: examine the diversity of knowledge translation research and practice, build networks with other knowledge translation trainees, and advance the field through knowledge generation activities. In this article, we describe how the collaborative serves as an innovative community of practice for continuing education and professional development in knowledge translation and present a logic model that provides a framework for designing an evaluation of its impact as a community of practice. The expectation is that formal and informal networking will lead to knowledge sharing and knowledge generation opportunities that improve individual members' competencies (eg, combination of skills, abilities, and knowledge) in knowledge translation research and practice and contribute to the development and advancement of the knowledge translation field.

OBJECTIVE: To examine a school-based high-intensity neuromuscular training (NMT) program in reducing sport injury risk and improving fitness in youth. PARTICIPANTS: Students (ages 11-15) (n = 725) in physical education (PE) classes were randomized by school to intervention or control groups. INTERVENTION: A 12-week high-intensity NMT program (including aerobic, strength, balance, and agility components) was designed to reduce sport injury risk and improve measures of fitness. The control program was a standard of practice warm-up (including running and stretching). RESULTS: A Poisson regression model using an intent-to-treat analysis demonstrated a reduced risk of sport injury: incidence rate ratio (IRR)all injury = 0.30 (95% CI, 0.19-0.49), IRRlower extremity injury = 0.31 (95% CI, 0.19-0.51), IRRankle sprain injury = 0.27 (95% CI, 0.15-0.50), and IRRknee sprain injury = 0.36 (95% CI, 0.13-0.98). A change in waist circumference: -0.99 centimeters (95% CI, -1.84 to -0.14) and an increase in indirect measures of aerobic fitness: 1.28 mL·kg·min (95% CI, 0.66-1.90) in the intervention school compared with the control school also occurred. CONCLUSIONS: A NMT program in junior high school PE class was efficacious in reducing sport-related injury and improving measures of adiposity and fitness in the intervention group. Language: en

Objectives. To examine body mass index (BMI) and waist circumference (WC) as risk factors for sport injury in adolescents.Design. A secondary analysis of prospectively collected data from a pilot cluster randomized controlled trial.Methods. Adolescents (n=1,040) at the ages of 11–15 years from two Calgary junior high schools were included. BMI (kg/m2) and WC (cm) were measured from direct measures at baseline assessment. Categories (overweight/obese) were created using validated international (BMI) and national (WC) cut-off points. A Poisson regression analysis controlling for relevant covariates (sex, previous injury, sport participation, intervention group, and aerobic fitness level) estimated the risk of sport injury [incidence rate ratios (IRR) with 95% confidence intervals (CI)].Results. There was an increased risk of time loss injury (IRR = 2.82, 95% CI: 1.01–8.04) and knee injury (IRR = 2.07, 95% CI: 1.00–6.94) in adolescents that were overweight/obese; however, increases in injury risk for all injury and lower extremity injury were not statistically significant. Estimates suggested a greater risk of time loss injury [IRR = 1.63 (95% CI: 0.93–2.47)] in adolescents with high measures of WC.Conclusions. There is an increased risk of time loss injury and knee injury in overweight/obese adolescents. Sport injury prevention training programs should include strategies that target all known risk factors for injury.

OBJECTIVES: To examine unintentional injury mortality rates in children (0−19 years) in Canada from 1950 to 2009 against national population-level injury prevention interventions. METHODS: Injury mortality rates were age and sex adjusted. Changes in trend and level of mortality rates were assessed at pre-specified intervention periods using segmented linear regression analyses for interrupted time series. Maximum likelihood estimation was used with a second order autoregressive error process. RESULTS: From 1950 to 2009, the overall unintentional injury mortality rate decreased by 86%. Males had consistently higher mortality rates compared to females; however, the standardized rate ratio decreased from 2.37:1 in 1950 to 1.97:1 in 2009. Substantial declines in choking/suffocation deaths were noted in children less than 1 year of age, predominantly during the period 1970−1988 when the Hazardous Products Act and Crib Regulations were implemented. For burns, significant changes in slope were noted comparing 1972–1994 to pre-1971 (introduction of the Hazardous Products Act – Flammability Regulations), where the greatest decline was noted in children ages 1–4 years (Est. = −0.03, 95% CI = −0.02, −0.04). For 15−19 year olds, there was a 408% increase in motor vehicle collision-related mortality rates between 1950 and 1971; however a significant change in slope was noted during the period 1978–1985, compared to 1972–1977 (Est. = −0.10, 95% CI = −0.20, −0.007) across all age groups. CONCLUSION: While this study is not a cause and effect analysis, there is a strong association with implementation of safety campaigns and legislative changes related to child safety and a dramatic decline in childhood fatalities related to injury.

The objective of this study was to examine the impact of pedestrian countdown signals (PCS) on the rate of motor vehicle collisions (MVCs) in Toronto, Canada. A quasi-experimental design was used to compare rates of single and two vehicle MVCs before and after installation of PCS in Toronto, Canada between January 2005 and December 2009. Collision incidence rates were compared using Poisson regression analyses with adjustment for relevant cofounders and reported as incidence rate ratios (IRR) with 95% confidence intervals (CI). Secondary analyses were performed on subsets of collisions by collision type and injury severity. A total of 94,175 MVCs occurred at or near 1965 intersections at which PCS were installed over the five-year study period. Overall, the MVC incidence rate increased 7.5% (IRR = 1.075; 95% CI: 1.042-1.109; p < 0.0001) after installation of PCS. The installation of PCS led to an increase in MVCs. PCS may have an unintended consequence of increasing the rate of MVCs.

BACKGROUND: Injury is the leading cause of death from birth to age 34 in Canada (Statistics Canada, 2008). In 2013, a national injury prevention organization in Canada initiated a research-practitioner collaboration to establish a framework for incorporating evidence in the organization's decision-making. In this study, we outline the development process and provide an overview of the framework. METHODS: The process of development of the evidence-synthesis framework included consultation with national and international injury prevention experts, a review of the research literature to identify existing models for incorporating research evidence into public health practice and extensive interactions with the organization's leadership and staff. RESULTS: A framework emphasizing four types of research evidence was recommended: (i) epidemiologic evidence describing the burden and cause of injury, (ii) evidence concerning the effectiveness of interventions, (iii) evidence on effective methods for implementing promising interventions at a population level, and (iv) evidence and theory from the behavioral sciences. Through the evidence-synthesis process the framework prioritizes highly synthesized evidence-based strategies and draws attention to important research gaps. CONCLUSIONS: This study describes a novel opportunity to operationalize an organization's commitment to integrate evidence into practice. The framework provides guidance on how to use evidence strategically to maximize the potential impact of prevention efforts. Opportunities for further evaluation and dissemination are discussed. Language: en

The aim is to describe the epidemiology of yoga injuries presenting to select Canadian emergency departments (EDs). Those who presented with a yoga injury to a Canadian ED participating in the Canadian Hospitals Injury Reporting and Prevention Program and had completed a data collection form between 1991 and 2010 were included. Demographic and injury characteristics were tabulated and injury profiles of children were compared to adults. Sixty-six individuals (48 female, 18 male) who sustained 67 injuries were included. The median age was 19 (intraquartile range: 13, 32) and 73% of individuals were injured after 2005 (p = 0.0003). Sprain was the most common injury (23/67, 34%) and the most common body region injured was the lower extremity (27/67, 42%). Significantly more children were injured while being instructed than adults (p = 0.003) but more adults required treatment (p = 0.023). Although yoga-related injuries presenting to an ED are not common, the number of injuries are increasing.

There is a critical need for scientists to incorporate a knowledge translation (KT) perspective into research plans to demonstrate the relevance of research findings and evaluate their implications for health practice and policy. Since 2011, the British Journal of Sport Medicine ( BJSM ) has had a focus on implementation and dissemination research.1 This field is consistent with KT, which is the term used by the Canadian Institutes of Health Research (CIHR). As the following research example was conducted in Canada, the terminology KT is used, acknowledging similarities to implementation and dissemination concepts referred to elsewhere in BJSM . Using an interdisciplinary approach, the knowledge exchange process should influence healthcare professionals, community members and other decision-making groups. On the basis of the original model developed by van Mechelen et al ,2 injury prevention research in sport includes identification of injury burden, examination of risk factors, and development, implementation and evaluation of prevention strategies to reduce injury risk. As sport injury prevention programmes cannot be impactful without acceptance and adoption by targeted individuals, an extension of this model must include real-world implementation contexts and evaluation of their effectiveness in a broader, ecological context (figure 1).3 Figure 1 Sport Injury Prevention Research Centre adapted integrated knowledge translation model. The prevention of injuries and their long-term …

When used correctly, child safety seats reduce the risk of injury to a child passenger compared to seat belts. The objectives of this study are to (1) describe restraint use among Canadian children ages 4-8 years in 2010; (2) compare child safety seat use between provinces with new legislation (post-2006), old legislation (pre-2006), and without legislation; and (3) compare child safety seat use rates from 2006 to 2010.Roadside observational surveys of child restraint use were performed in 2006 and 2010 using a nationally representative stratified sample. Proportions of restraint use, correct use (i.e., child safety seats and booster seats) in 4- to 8-year-old children was examined between 3 groups: provinces with new legislation (i.e., child safety seat legislation that included implementation of specific legislation for booster seat use for child passengers ages 4-8 years), old legislation, and no legislation.There were 4048 children observed as passengers in motor vehicles. In provinces with new legislation, 84 percent (95% confidence interval [CI], 72.2-90.8) of children were restrained compared to 94.9 percent (95% CI, 93.0-96.7) in provinces with old legislation, and 81.8 percent (95% CI, 77.3-86.3) in provinces without legislation. Correct use of child restraint was 54.1 percent (95% CI, 48.0-60.3) in provinces with new legislation, 29.5 percent (95% CI, 25.9-33.2) in provinces with old legislation, and 52.0 percent (43.0-61.0) in provinces without legislation in 2010.The findings from this study suggest that child safety seat legislation has an impact on restraint use in Canada. Despite the increase in rates of child safety seat use in provinces with new legislation and stable rates in provinces with old legislation, use rates remain low. Injury prevention strategies including further surveillance, interventions, and enforcement of restraint use in children are important to decrease motor vehicle related injury and death.

Background and Objectives The frequency of pedestrian collisions is strongly influenced by the built environment, including road width, street connectivity and public transit design. In 2010, 2159 pedestrian collisions were reported in the City of Toronto, Canada with 20 fatalities. Previous studies have reported that streetcars operating in mixed traffic pose safety risks to pedestrians; however, few studies evaluate the effects on pedestrian-motor vehicle collisions (PMVC). The objective of this study was to examine changes in the rate and spatial patterning of PMVC, pre to post right-of-way (ROW) installation of the St. Clair Avenue West streetcar in the City of Toronto, Canada. Methods A quasi-experimental design was used to evaluate changes in PMVC rate, following implementation of a streetcar ROW. Collision data were extracted from all police-reported PMVC, complied and verified by the City of Toronto, from January 1, 2000 to December 31, 2011. A zero-inflated Poisson regression analysis estimated the change in PMVC, pre to post ROW. Age and injury severity were also examined. Changes in the spatial pattern of collisions were examined by applying the G function to describe the proportion of collision events that shared a nearest neighbor distance less than or equal to a threshold distance. Results A total of 23,607 PMVC occurred on roadways during the study period; 441 occurring on St. Clair Ave, 153 during the period of analysis. There was a 48% decrease in the rate of collisions on St. Clair [Incidence rate ratio (IRR) = 0.52, 95% CI: 0.37–0.74], post ROW installation. There were also decreases noted for children (IRR = 0.13, 95% CI: 0.04–0.44), adults (IRR = 0.61, 95% CI: 0.38–0.97), and minor injuries (IRR = 0.56, 95% CI: 0.40–0.80). Spatial analyses indicated increased dispersion of collision events across each redeveloped route segment following the changes in ROW design. Conclusions/Implications Construction of a raised ROW operating on St. Clair Ave. was associated with a reduction in the rate of collisions. Differences in pre- and post collision spatial structure indicated changes in collision locations. Results from this study suggest that a streetcar ROW may be a safer alternative for pedestrians compared to a mixed traffic streetcar route and should be considered by city planners where appropriate to the street environment.

Background Educational resources are important tools in the implementation of sport injury prevention strategies to help foster uptake of information in a community setting; however, there is limited information on how these tools are developed. Objective To develop two injury prevention educational tools targeting children and adolescents for evaluation in school and community settings. Design Qualitative. Setting Schools and ski/snowboard facilities in Calgary, Canada. Participants Key informants, including: 1) Community stakeholders from school and ski/snowboard settings, 2) Students ages 9–14 years, and 3) Ski/snowboard instructors, safety patrols and physical education (PE) specialists. Interventions Semi-structured focus groups and surveys were conducted with key stakeholders to explore pre-understandings, relevant content, delivery methods, and format of the tools. Consultations with community partners, PE specialists and ski/snowboard instructors and patrols helped further inform content and format during the development process. Main Outcome Measurements Videos and posters were developed based on feedback and discussions with key informants. These tools were designed as educational resources for teacher and student evaluation in two injury prevention studies. Results Videos were the main tools developed for the school-based delivery; including content about a neuromuscular training program and ski/snowboard safety strategies targeting injury prevention in youth sport. Focus group participants and informants emphasized the importance of understanding the target audience and adapting content and delivery approaches that increase the likelihood of successful uptake of key messages. This included communicating information in a clear and concise manner and utilizing visual and auditory cues to accommodate multiple learning styles. A health behaviour framework (i.e., Health Action Process Approach) was used to inform tool development. Conclusions Engaging informants supported the development of sport injury prevention educational tools. These tools are being utilized in studies evaluating their effectiveness in increasing knowledge, changing behaviour and reducing the risk of sport-related injury in school and community settings.

Background Obesity, defined as an accumulation of excessive fat mass that impairs health, is associated with lower levels of neuromuscular control including balance and coordination, which may place youth with higher adiposity at greater risk for injury during sport participation. On the opposite end of the spectrum, excessively low fat mass can also pose an injury risk. Objective To determine if adiposity is a risk factor for sport injury in children and adolescents. Design Systematic Review. Methods Ten electronic databases were systematically searched using key words and Medical Sub-Heading terms. Studies selected included: English language; original data; analytic design; adiposity measurement by age- and sex-adjusted body mass index (BMI) or body fat using imaging, impedance or predictive methods and; children, adolescents and young adults ≤20 years who sustained a musculoskeletal injury during sport or recreation participation that resulted in medical attention or time loss from sport or activities. PRISMA guidelines were followed and studies were assessed by two independent raters. Level of evidence was assessed using the Oxford Centre of Evidence-Based Medicine model. Results Of 8029 potentially relevant records, 44 were included in the final review. 75% of these studies were of prospective cohort design (level 2b evidence). Twenty-one studies concluded that a BMI rating of overweight/obese is a significant risk factor for injury; the majority (12/21) of these studies assessed lower extremity injury (e.g. ankle sprain and medial tibial stress syndrome). Nineteen studies showed no association between anthropometric measurement and injury; the majority (14/19) assessed all sport injury. Finally, a BMI rating of underweight (4 studies) was more commonly associated with risk of stress fracture. Conclusions There is consistent level 2b evidence that a rating of overweight/obesity is associated with lower extremity injury. Anthropometric risk of injury appears to be dependent on type and site of injury in youth sport.