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IntroductionTraffic injury is a leading and preventable cause of child death and disability, with child pedestrians and cyclists particularly vulnerable. Examining built environment correlates of child pedestrian and cyclist motor vehicle collisions (PCMVC) in different settings is needed to promote an evidence-based approach to road safety.MethodsWe conducted a cross-sectional study across multiple urban/suburban environments in Canada (Calgary, Toronto, Montreal, Laval, Peel Region). All public elementary schools were included (n=1030). We examined the role of land use/social environments, road environments and traffic safety interventions on the rates of child PCMVC within 1000 m of schools. Multivariable negative binomial regression was conducted for all cities and by individual city. In a subset of schools (n=389), we examined associations when controlling for active school transportation (AST).ResultsMean PCMVC rate per school ranged from 0.13 collisions/year in Peel to 0.35 in Montreal. Child PCMVC were correlated with land use, social and road environments and traffic safety interventions. In fully adjusted models, social and land use features remained the most important correlates. New immigrant population had the largest positive association with child PCMVC (incidence rate ratio (IRR): 1.26, 95% CI 1.06 to 1.50), while old housing (pre-1960) density was most protective (IRR: 0.83, 95% CI 0.77 to 0.90). AST was associated with PCMVC, but it had no effect on the relationships between PCMVC and other social/environmental correlates.ConclusionThe built environment and social factors influence rates of child PCMVC. Opportunities to reduce child PCMVC exist through modifications to city design and road environments and implementing traffic safety interventions.

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

BackgroundPedestrians are commonly involved in vehicle collisions that result in injuries and fatalities. Pedestrian distraction has become an emerging safety issue as more pedestrians use their mobile phones while walking and crossing the street.ObjectivesThe purpose of this research synthesis and meta-analysis is to determine the extent to which cell phone conversation, text messaging or browsing, and listening to music affect a number of common pedestrian behavioural measures.MethodsA keyword search was developed with a subject librarian that used MeSH terms from selected databases including PsycINFO, SPORTDiscus, Medline and TRID. Supplemental searches were also conducted with Google Scholar and Mendeley.Effect size codingThirty-three studies met inclusion criteria and were subjected to data extraction. Statistical information (ie, M, SD, SE, 95% CI, OR, F, t) was extracted to generate standardised mean difference effect sizes (ie, Cohen’s d) and r effect sizes.ResultsFourteen experimental studies were ultimately included in an N-weighted meta-analysis (k=81 effect sizes), and eight observational studies were included in a qualitative overview. Both mobile phone conversation and text messaging increased rates of hits and close calls. Texting decreased rates of looking left and right prior to and/or during street crossing. As might be expected, text messaging was generally found to have the most detrimental effect on multiple behavioural measures.LimitationsA variety of study quality issues limit the interpretation and generalisation of the results, which are described, as are future study measurement and methods improvements.

Environmental audit tools must be reliable in order to accurately estimate the association between built environmental characteristics and bicycling injury risk.To examine the inter-rater agreement of a built environment audit tool within a case-control study on the environmental determinants of bicycling injuries.Auditor pairs visited locations where bicycling injuries occurred and independently recorded location characteristics using the Systematic Pedestrian and Cyclist Environmental Scan (SPACES). Two case groups were defined: (1) where a bicyclist was struck by a motor-vehicle (MV) and (2) where the bicyclist's injuries required hospitalisation. The two corresponding control groups were (1) where non-MV bicycle-related injuries occurred and (2) where minor bicycle-related injuries occurred. Inter-rater reliability of each item on the tool was assessed using observed agreement and κ with 95% CI.Ninety-seven locations were audited. Inter-observer agreement was generally high (≥95%); most items had a 1-2% difference in responses. Items with ≥5% differences between raters included path condition, slope and obstructions. For land use, path and roadway characteristics, κ ranged from 0.3 for presence of offices and cleanliness to 0.9 for schools and number of lanes; overall, 78% of items had at least substantial agreement (κ≥0.61). For bicyclists struck by a MV the proportion of items with substantial agreement was 60%, compared with 73% for non-MV related injuries. For hospitalisations and minor bicycle-related injuries, 76% of items had substantial agreement.Agreement was substantial for most, but not all SPACES items. The SPACES provides reliable quantitative descriptions of built environmental characteristics at bicycling injury locations.

Background The international classification of diseases version 10 (ICD-10) uses alphanumeric expanded codes and external cause of injury codes (E-codes). Objective To examine the reliability and validity of emergency department (ED) coders in applying E-codes in ICD-9 and -10. Methods Bicycle and pedestrian injuries were identified from the ED information system from one period before and two periods after transition from ICD-9 to -10 coding. Overall, 180 randomly selected bicycle and pedestrian injury charts were reviewed as the reference standard (RS). Original E-codes assigned by ED coders (ICD-9 in 2001 and ICD-10 in 2004 and 2007) were compared with charts (validity) and also to ICD-9 and -10 codes assigned from RS chart review, to each case by an independent (IND) coder (reliability). Sensitivity, specificity, simple, and chance-corrected agreements (κ statistics) were calculated. Results Sensitivity of E-coding bicycle injuries by the IND coder in comparison with the RS ranged from 95.1% (95% CI 86.3 to 99.0) to 100% (95% CI 94.0 to 100.0) for both ICD-9 and -10. Sensitivity of ED coders in E-coding bicycle injuries ranged from 90.2% (95% CI 79.8 to 96.3) to 96.7% (95% CI 88.5 to 99.6). The sensitivity estimates for the IND coder ranged from 25.0% (95% CI 14.7 to 37.9) to 45.0% (95% CI 32.1 to 58.4) for pedestrian injuries for both ICD-9 and -10. Conclusion Bicycle injuries are coded in a reliable and valid manner; however, pedestrian injuries are often miscoded as falls. These results have important implications for injury surveillance research.

Objective To provide an overview of the two-stage case–control study design and its potential application to ED injury surveillance data and to apply this approach to published ED data on the relation between brain injury and bicycle helmet use. Methods Relevant background is presented on injury aetiology and case–control methodology with extension to the two-stage case–control design in the context of ED injury surveillance. The design is then applied to data from a published case–control study of the relation between brain injury and bicycle helmet use with motor vehicle involvement considered as a potential confounder. Taking into account the additional sampling at the second stage, the adjusted and corrected odds ratio and 95% confidence interval for the brain injury–helmet use relation is presented and compared with the estimate from the entire original dataset. Contexts where the two-stage case–control study design might be most appropriately applied to ED injury surveillance data are suggested. Results The adjusted odds ratio for the relation between brain injury and bicycle helmet use based on all data (n=2833) from the original study was 0.34 (95% CI 0.25 to 0.46) compared with an estimate from a two-stage case–control design of 0.35 (95% CI 0.25 to 0.48) using only a fraction of the original subjects (n=480). Conclusion Application of the two-stage case–control study design to ED injury surveillance data has the potential to dramatically reduce study time and resource costs with acceptable losses in statistical efficiency.

Background Incorrect bicycle helmet use increases head injury risk. Objective To evaluate the patterns of incorrect helmet use based on unobtrusive field observations. Methods Two observational surveys conducted in Alberta in 2000 and 2006 captured information on cyclist characteristics, including correct helmet use. Prevalence of correct helmet use was compared across multiple factors: age, gender, riding companionship, and environmental factors such as riding location, neighbourhood median family income, and region. Poisson regression analysis was used to relate predictor variables to the prevalence of incorrect helmet use, adjusting for clustering by site of observation. Results Among helmeted cyclists (n=5862), 15.3% were wearing their helmet incorrectly or were using a non-bicycle helmet. Children (53%) and adults (51%) tended to wear their helmet too far back, while adolescents tended not have their straps fastened (48%). Incorrect helmet use declined approximately 50% over the study period for children and adolescents, but 76% (95% CI 68% to 82%) in adults. Children were 1.8 times more likely to use their helmets incorrectly in 2000 compared with adults, but this effect increased to 3.9 (95% CI 2.9 to 5.4) in 2006. Adolescents were more likely to use their helmets incorrectly in 2006 compared with adults (prevalence ratio 2.76; 95% CI 1.9 to 4.02). Children and adolescents cycling alone, compared with adults cycling alone, cycling at non-school sites and cycling in Edmonton, was associated with incorrect helmet use. Conclusions Important factors not previously identified were associated with incorrect bicycle helmet use. This information can be used to target interventions to increase correct use.

Background: Bicycle helmets effectively reduce the risk of bicycle-related head injuries and trauma; however, they must fit properly to be effective. Little is known about the prevalence of correctly worn helmets and factors associated with proper helmet use. Objective: To examine proper bicycle helmet use through a systematic review. Methods: Comprehensive searches of electronic medical databases were performed, and completed by grey literature and reference list checks to identify eligible studies. Studies eligible for inclusion had to involve cyclists and report on the prevalence of correct or incorrect helmet use. Two reviewers independently selected studies and data were extracted regarding the prevalence and factors influencing proper helmet wearing of cyclists. Results: An inclusive search strategy led to 2285 prescreened citations; 11 of the studies were finally included in the review. Overall, correct helmet use varied from 46% to 100%, depending on the criteria used by researchers to define proper helmet use; stricter criteria reduced the proportion of properly worn helmets. Adulthood, female sex and educational interventions were associated with correct helmet use in some studies. Self-reported poor helmet fit (OR = 1.96; 95% CI 1.10 to 3.75), posterior positioning of helmet (OR = 1.52; 95% CI 1.02 to 2.26) and helmet loss in crash (OR = 3.25; 95% CI 1.82 to 5.75) increased the risk of head injury. In addition, educational programmes on helmet use in schools increased correct helmet use among schoolchildren. Conclusions: This systematic review outlines the current state of the literature including the variability in research methodology and definitions used to study proper helmet-wearing behaviour among cyclists.

Background: Deficiencies in emergency department (ED) charting is a common international problem. While unintentional falls account for the largest proportion of injury related ED visits by youth, insufficient charting details result in more than one third of these falls being coded as “unspecified”. Non-specific coding compromises the utility of injury surveillance data. Objective: To re-examine the ED charts of unspecified youth falls to determine the possibility of assigning more specific codes. Methods: 400 ED charts for youth (aged 0–19 years) treated at four EDs in an urban Canadian health region between 1997 and 1999 and coded as “Other or unspecified fall” (ICD-9 E888) were randomly selected. A structured chart review was completed and a blinded nosologist recoded the cause of injury using the extracted data. Differences in coding specificity were compared with the original data, and logistic regression was undertaken to examine variables that predicted assignment of a specific E-code. Results: A more specific code was assigned to 46% of cases initially coded as unspecified. Of these, 73% were recoded as “Slips, trips, and stumbles” (E885), which still lacks the specificity required for injury prevention planning; 2% of charts had no fall documented. Multivariate analysis revealed that dichotomized injury severity (adjusted odds ratio (OR) = 1.75 (95% confidence interval, 1.11 to 2.78)), arrival at the ED by ambulance (adjusted OR = 5.41 (1.07 to 27.0)), and the availability of nurse’s notes or triage forms, or both, in the chart (adjusted OR = 3.75 (2.17 to 6.45)) were the strongest predictors of a more specific E-code assignment. Conclusions: Deficiencies in both chart documentation and coding specificity contribute to the use of non-specific E-codes. More comprehensive triage coding, improved chart documentation, and alternative methods of data collection in the acute care setting are required to improve ED injury surveillance initiatives.

Objective: To determine the reliability of reporting of information on risk factors from a standard accident report form used by ski patrols and a follow up mail questionnaire or telephone interview among injured skiers and snowboarders. Setting: 19 ski areas in the Canadian province of Quebec between November 2001 and April 2002. Participants: 4377 injured skiers and snowboarders seen by the ski patrol, who completed a follow up mail questionnaire or telephone interview. Main outcome measures: κ and weighted κ statistics were used to measure the chance corrected agreement for self reported ability, age, skiing time on day of injury, lessons, type of practice, use of helmet at time of injury, and hill difficulty. Results: The κ value for helmet use at the time of injury was 0.88 (95% confidence interval 0.87 to 0.90) and for other risk factors ranged from 0.45 (skiing time on day of injury) to 0.98 (age). Few differences were seen in reporting by body region of injury. Reporting consistency was lower for respondents who completed telephone interviews compared with those who completed mail questionnaires and those who responded more than four months after the injury. Conclusions: Moderate to almost perfect agreement, depending on the risk factor, exists between ski patrols' accident report forms and follow up information. Ski patrol reports can be a reliable and readily available source of information on risk factors for skiing and snowboarding.

Background The standard response time benchmark for Emergency Medical Services (EMS) has been set at eight minutes or less for ground ambulances in many parts of the world. It has not been extensively studied, especially in paediatric patients who suffered a traumatic injury. As injury is the leading cause of death for those under the age of 18 it is important to determine if this benchmark for EMS response time may be a factor in paediatric mortality and morbidity outcomes. Methods All paediatric calls made to EMS between April 2010 to September 2013 in the cities of Calgary and Edmonton, Alberta, Canada were examined to select patients who had suffered a traumatic injury. These records were then linked to emergency department records and hospitalisation records using a deterministic linkage strategy using personal healthcare number, sex, and receiving facility. Patients were excluded if they were ≥18 years old, attended to outside of Calgary or Edmonton areas or suffered a medical complaint not related to an injury. Response time, the exposure, was defined as time of call to 9–1–1 to arrival of ambulance on scene. Response time was dichotomized into Results 42 620 patients were attended to between April 2010 and September 2013. Overall, 6778 patients were included in the study. 52 patients died and 628 patients were admitted to hospital. The adjusted mortality risk ratio given a response time of ≥8 minutes was 0.635 (95% CI: 0.346–1.166; p = 0.143). The adjusted hospital admission risk ratio given a response time of ≥8 minutes was 1.165 (95% CI: 0.985–1.379; p = 0.075). Conclusions A response time of ≥8 minutes was not associated with a difference in all cause mortality or hospital admission for paediatric patients suffering from a traumatic injury.

Background Sport injuries are a significant burden, and while there are studies demonstrating the effectiveness of injury prevention programs, there is less guidance on how they are adopted and implemented successfully. The aim of this project was to conduct a process and formative evaluation of an injury prevention program implemented in a school setting. Methods This study proposes two frameworks [RE-AIM and the Consolidated Framework for Implementation Research (CFIR)] to evaluate the implementation of a neuromuscular training program (iSPRINT) to reduce sport injury and improve health-related measures in a junior high school population. The five dimensions of the RE-AIM and CIFR frameworks will be used. Results A total of 245/320 students were willing to participate in the program (68% reach). There was a lower risk of injury in intervention schools (n = 2) compared to controls (n = 2) [RR = 0.52 (95% CI: 0.33–0.81)]. 76% of students and 83% of teachers reported positive attitudes towards the program, 60% of students reported they believed the program could reduce the risk of injury, and 74% reported the program could improve fitness. 14% of the schools approached agreed to participate in the program (adoption). For students, the most frequently reported reason for participating was the belief that the program would reduce injury and increase fitness. Factors related to successful implementation of the program in schools included clear explanation and demonstration of the program, and barriers included difficulty in executing certain program components. Finally, 88% of teachers reported interest in maintaining the program. Ongoing formative evaluation will be collected via focus groups using CFIR constructs (2015–2016). Conclusions Teachers were able and keen to continue to use the iSPRINT program. We will provide further discussion on the dimensions of REAIM, and report the specific constructs that facilitated and impeded implementation of the iSPRINT program.

Background Bicycling injuries in young people represent a substantial cost to health care systems. The objective of this review was to examine the individual and environmental factors associated with bicycling-related injury risk in children and youth. Methods Fourteen electronic databases were searched using exploded subject headings and keywords. Two authors independently screened article titles and abstracts for inclusion. The full-text of the potential articles was assessed to determine eligibility. The inclusion criteria were bicyclists less than 18 years old; individual and environmental characteristics of bicycling outcomes; comparisons between injured and uninjured bicyclists, injury type or severity level; study designs with a pre-determined comparison group; and publications in English from 1990 to May 2015. The exclusion criteria were injury outcomes related to helmet use, helmet legislation or mountain biking; comparisons of census-based injury rates; cross-sectional studies; and letters to the editor. A modified version of the Newcastle-Ottawa Scale was used to assess study quality. Results Fifteen articles met the inclusion and exclusion criteria. Overall, 46 different risk factors were examined. The most commonly reported risk factors were age (N = 10 studies), sex (N = 7), equipment related factors (N = 6), bicycling exposure (N = 5), bicycling purpose (N = 5), and motor vehicle (MV) collision (N = 4). The reviewed studies varied in quality; the main weaknesses were inadequate definitions of study groups, lack of control for potential confounders, and the use of self-reported data. Conclusions While many of the studies had significant limitations, one recurring theme was that young bicyclists received more severe injuries when exposed to MV collisions. To reduce injuries in children and adolescents, we recommend separating bicyclists from MVs on the road and implementing strategies to reduce traffic speed and volume.

Background There are few studies on the relationship between the severity of bicycle-related injury in children and characteristics of the built environment. Methods Emergency Medical Services (EMS) 9–1–1 calls completed between 2010–2013 in Calgary and Edmonton, Alberta, Canada for bicycle injury events in children Results Among all paediatric EMS calls that were linked to a health care database, 575 involved bicycle injuries. To date, we have completed 157 location audits using the PEDS instrument with Google Maps. Analysis of audits completed to date indicates 83% of the subjects were male. Almost half (45%) of all injuries occurred on road segments with intersections. Two-thirds of injuries occurred at locations with a lack of street crossing aids. Conclusions We have made progress toward profiling the individual and environmental characteristics of bicycle injuries. Next steps involve completing this process for the remaining injury locations. Injuries requiring hospital admission (i.e., severe injuries) will be compared with the ones that did not (i.e., non-severe injuries) for personal (e.g., age, sex) and location (e.g., presence of intersection) variables.

Background (issue/problem) Building strong partnerships between researchers and the community in youth sport and recreational injury prevention to promote active living and prevent chronic disease is a timely priority. Engaging community partners throughout the research process, from planning to dissemination, is critical to ensure project success, effective knowledge translation (KT) and impact. Description of the problem Involvement of community stakeholders in research often includes pre-grant solicitation of support or end-phase KT activities. To facilitate optimal and timely input from key stakeholders at all stages of research, the Alberta Program in Youth Sport and Recreational Injury Prevention developed a Knowledge Broker (KB) model. Results (effects/changes) In alignment with research priorities, KBs were identified in relevant community partner organisations (Ever Active Schools, Hockey Calgary, WinSport). KBs bridge the gap between research, education and KT priorities within the academic institution and the community. KB activities include contributing to research questions, intervention development, subject recruitment, implementation and dissemination of findings. Linking researchers and knowledge users facilitates collaboration, a greater understanding of common and diverse goals, and new partnerships. The ideal outcome of these partnerships includes optimal knowledge exchange to maximise the uptake of research evidence for the greatest public health impact. A financial contribution from the research program helps support the commitment of KBs. Conclusions The integrated nature of the research program with academic and community stakeholder partnerships, creates an ideal setting for enhancing the impact of KT. KB involvement contributes significantly to achieving research objectives. KB contributions optimise the translation of research findings into injury prevention practice, programs and policies.

Background From 1995 to 2000, the rate of injury in Quebec, Canada, ski areas significantly increased. This problem coincided with an increase in the number of snow-parks. Before suggesting injury prevention measures, some questions had to be answered: Are helmets effective? Does helmet use result in a false-sense of security? Can head-neck-helmet biomechanics increase spinal injury risk? Do expert skiers and snowboarders need a helmet? Is there an increased risk of serious injury in snow-parks? The aim of this paper is to outline how a series of epidemiologic studies significantly contributed to support the implementation of important safety measures in alpine ski areas. Methods A series of case-control studies were undertaken. They were based on the information gathered through ski patrol injury report forms (IRF). Depending on the specific study, between 4,377 and 97,408 IRFs were analysed. Results The results of these studies suggest that: helmets are effective in reducing the risk of any head injury (adjusted odds ratio [AOR] = 0.71; 95% CI: 0.55–0.92); helmet use is not associated with a false-sense of security leading to riskier behaviours; helmets do not increase the risk of neck injuries; expert alpine skiers are at greater risk of head-neck injuries compared with beginners (AOR = 1.86, 95% CI: 1.65–2.10); for skiers (AOR = 1.36; 95% CI: 1.21–1.53) and snowboarders (AOR = 1.14, 95% CI: 1.05–1.23), injuries sustained in snow-parks compared with other slopes are more likely to require ambulance evacuation. Conclusions Considering this evidence, the Quebec Government modified a provincial regulation to make compulsory the use of helmets in all snow-parks. The Quebec Ski Areas Association and the Quebec Government also implemented a practical guide for building and operating snow-parks. Results show a reduction in the rates of head-neck injury from 1997–1998 season (5.07/10,000 visits; 95% CI: 4.84–5.31) to 2012–2013 season (3.27/10,000 visits; 95% CI: 3.13–3.41).

Background Identification of environmental risk factors for bicycling injuries could lead to improved safety and increased bicycling. Objectives To identify built environment characteristics associated with bicycling injuries. Methods Participants were recruited from seven emergency departments (ED) in Alberta, Canada. Cases were bicyclists struck by a motor-vehicle (MV) or with severe injuries (hospitalised). Controls were bicyclists who were not hit by a car or those seen and discharged from the ED, matched on day and time. Crash details were collected by interview and chart reviews. Environmental audits performed at injury locations captured path, roadway, safety, land use, and aesthetic characteristics. Logistic regression OR adjusted for age, sex, peak time, and bicyclist speed with 95% CI were estimated to relate injury risk to environmental characteristics. Results We audited 274 locations (70 case sites). A higher proportion of MV cases than controls (35.7% vs 11.3%) were commuting. Based on the unmatched analyses, the odds of a MV event were higher at locations with greater traffic volume (OR 3.5; 95% CI 1.4 to 8.9), intersections (OR 2.8; 95% CI 1.1 to 7.2), path obstructions (OR 2.6; 95% CI 1.1 to 5.9), and retail land use (OR 7.5; 95% CI 3.1 to 18.0). Locations with street lights (OR 0.4; 95% CI 0.2 to 0.9), high surveillance (OR 0.3; 95% CI 0.1 to 0.8), or good road condition (OR 0.4; 95% CI 0.2 to 0.9) reduced severe injury risk. Results were similar based on matched analyses. Significance Built environmental risk factors for bicyclist injury were identified and could be modified to increase safety and encourage more bicycling.

Background Ice hockey has high participation and injury rates in youth in Canada. Body checking (BC) is the predominant mechanism of injury. Research has informed policy change disallowing BC in non-elite Pee Wee leagues (ages 11–12) in some provinces. Objective The objective of this study was to determine if the risk of injury and concussion differ for non-elite Pee Wee ice hockey players in leagues where BC is permitted (Alberta) versus leagues where policy no longer permits BC (Ontario). Methods This is a cohort study completed in Alberta and Ontario during the 2011/2012 season. Players were from Pee Wee teams in the lower 70% of divisions of play. A previously validated injury surveillance system was used to collect preseason, exposure and injury data. Results Forty-four teams from Alberta (n=658) and 32 from Ontario (n=258) participated. There were 144 injuries (Incidence Proportion (IP)=21.88 (95% CI 18.78 to 25.24)) and 83 concussions (IP)=12.61 (95% CI 10.17 to 15.4)) in Alberta and 17 injuries (IP=6.59 (95% CI 3.88 to 10.34)) and 11 concussions (IP=4.26 (95% CI 2.15 to 7.5)) in Ontario. The Alberta versus Ontario Risk Ratio was 3.34 (95% CI 2.06 to 5.41) for all injury and 2.96 (95% CI 1.6 to 5.46). for concussion. Significance There was a 3-fold increased risk of injury and concussion in non-elite Pee Wee ice hockey players in leagues where BC is permitted compared to a cohort where BC is no longer permitted. These findings have important implications for further BC policy change to reduce the public health burden of injury and concussion in youth ice hockey.

Background Environmental audit tools must be valid in order to accurately estimate the association between built environmental characteristics and bicycling injury risk. Objectives To examine the inter-rater reliability of a built environment audit tool in a case-control study on the environmental determinants of bicycling injuries. Methods Auditor pairs visited locations where bicycling injuries were known to have occurred in two cities, and recorded location characteristics using the validated Systematic Pedestrian and Cyclist Environmental Scan (SPACES). Case locations were those where a bicyclist was struck by a motor-vehicle (MV), or suffered injuries requiring hospitalisation. Control locations were those where non-MV or minor injuries occurred. Inter-rater reliability of each item on the tool was assessed using observed agreement and Kappa (κ). Results Ninety-seven locations were audited from May–October 2010. Inter-observer agreement was generally high (≥95%); most items had a 1–2% difference in responses. Items with differences ≥5% between raters included path condition, slope, and obstructions. For land use, path, and roadway characteristics, κ ranged from 0.3 for presence of offices and cleanliness to 0.9 for schools and number of lanes; overall, 78% of items had high agreement (κ≥0.61). For MV cases the proportion of items with high agreement was 60%, compared with 73% for controls. For both severe cases and controls, 76% of items had high agreement. Significance Despite low reliability for land use types and cleanliness, percent agreement was high for most items. Our findings suggest that the SPACES tool provides reliable quantitative descriptions of built environmental characteristics at bicycle injury locations.

Background Evidence indicates that snow-park (SP) injuries are more severe than injuries on regular slopes. This prompted two major ski areas in the province of Quebec, Canada, to remove all man-made jumps from their SPs before the 2007-2008 season. Objective To determine if removing jumps from SPs reduced the prevalence of severe injuries for skiers and snowboarders. Methods Subjects were skiers and snowboarders who reported to the ski patrol with a SP injury at two ski areas before (seasons 2000-2001 to 2006-2007) and after (seasons 2007-2008 to 2009-2010) SP jumps were removed, and for all the ski areas with no SP jump removal. Severe injuries were defined based on type of injury or ambulance evacuation. We compared the proportion of severe injuries before and after SP jump removal with trends at the other areas. Logistic regression analysis was used to adjust the pre- and post change comparison for age, sex, skill level, helmet use, and type of activity. Results At the two hills that removed jumps, the proportion of severe injuries was 19.3% (600 severe SP injuries/3109 all SP injuries) before and 14.5% (63/434) after the change compared with 23.7% (2679/11 324) and 22.1% (921/4173) at other hills. After covariate adjustment, the odds of severe injuries declined at the two areas that removed jumps (adjusted OR (AOR): 0.72; 95% CI 0.54 to 0.97) with no change at other Quebec ski areas (AOR 0.98; 95% CI 0.83 to 1.08). Significance Results suggest that removing man-made jumps from SPs prevents severe injuries. This is an abstract of a presentation at Safety 2012, the 11th World Conference on Injury Prevention and Safety Promotion, 1-4 October 2012, Michael Fowler Center, Wellington, New Zealand. Full text does not seem to be available for this abstract.

Background There is limited literature regarding the effectiveness of visibility aids (eg, reflectors, lights, fluorescent clothing) in reducing the risk of a bicyclist- motor-vehicle (MV) collision. Objectives To determine if visibility aids reduce the risk of a bicyclist-MV collision. Methods Cases were bicyclists who were struck by a MV and assessed at emergency departments (EDs) from May 2008-October 2010 in Calgary and Edmonton, Alberta, Canada. Controls were bicyclists with non-MV injuries from the same EDs over the same time period. Participants were interviewed about their personal and injury characteristics, including use of visibility aids (clothing colour or reflective clothing, bike reflectors, etc). Injury information was collected from charts. ORs and 95% CIs were estimated for visibility aids after adjustment for confounders using logistic regression. Results There were 2403 injured bicyclists with 278 MV cases. The risk of a bicyclist-MV collision increased with age. Commuting also increased the odds of MV collision (OR 5.8; 95% CI 4.5 to 7.5). After accounting for location speed limit, bicyclist speed, and previous injury, white (OR 0.25; 95% CI 0.07 to 0.9) or other coloured (OR 0.45; 95% CI 0.2 to 0.9) compared with black clothing on the upper body reduced the odds of collision. Fluorescent clothing was associated with MV collisions (OR 1.7; 95% CI 1.0 to 2.8), even after adjusting for commuting and bicycling location. Significance Clothing choice may be important in reducing the risk of MV collision; however, factors beyond the individual also need to be examined.

The Vancouver Charter on Skiing Safety is based on skiing and snowboarding safety and the Turin Charter (approved in the context of the 2006 Turin Winter Olympic Games) and was brought to Canada by Safe Kids Canada. Originally prepared by a panel of experts and specialists delegated by European Governments who worked under the coordination of TOROC (Turin Organizing Committee), BE.PRA.S.A. (a project co-financed by the European Commission and the health authority of the Italian region of Veneto) and the Italian National Health Institute, the aim of the Charter is to promote a safe, healthy and active sporting and recreational culture, and to make its principles visible to the public, citizens and institutions. Over 30 international, national, provincial and municipal organisations have endorsed the Charter to date. The Charter was introduced at a Helmet Forum in November 2009 in Vancouver and featured experts such as Dr Charles Tator, Dr Richard Stanwick, Dr Brent Hagel and Mr Matt Herman. The forum was attended by injury prevention experts, ski/snowboard industry representatives and media and resulted in extensive national media coverage of the issue, especially the diversity of opinions and debates it has created. This presentation will show Safe Kids Canada9s experience of how the Charter can be leveraged by other countries, review the challenges and successes, present our knowledge translation ‘recipe for success’ and update the audience on activities to date.

Background Many injury studies involve samples of hospitalised or emergency room emergency department patients. In studies involving follow-up, consent is required when patients are first identified. When the proportion who refuse is high, the study sample may be biased in ways that distort the validity of the results. This study aimed to determine if wording requiring active consent resulted in more refusals than wording that was essentially passive that is where consent is implied in the absence of direct refusal. Methods The Canadian Hospital Injury Reporting and Prevention Program (CHIRPP) is based in 14 hospitals, 10 being paediatric. It uses a two-page questionnaire to describe how the injury occurred and what was injured. We chose 5 of the 10 paediatric hospitals; 3 used passive wording and 2 used active wording for consent to follow-up. We employed logistic regression to analyse the effect of wording on consent rates and whether the effect was influenced by patient demographic and clinical characteristics. Results 63% of parents gave consent for follow-up at hospitals using passive consent wording versus 53% where active wording was used. Refusals were highest for 15–19 year olds, families in lower income neighbourhoods, and motor vehicle passenger injuries. After covariate adjustment, passive wording increased likelihood of consent twofold. Conclusion Caution is needed when interpreting results from studies using hospital samples, especially when wording of consent for follow-up requires direct affirmation.

Editor,—The article by Dr Kopjar in a recent issue of the journal discussing the use of the population preventable fraction concerning bicycle related head injuries and helmet use was very interesting.1 Dr Kopjar uses the odds ratio (OR), obtained from case-control studies of the effectiveness of bicycle helmet use to prevent head injury, to provide an estimate of the relative risk (RR) required in the formula for the population attributable fraction. In the article, Dr Kopjar stated that “Incidence of head injuries is low, suggesting that these ORs can be used as a valid proxy for the RR”. …