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Background Alberta remains the only province in Canada without booster seat legislation. This presents an opportunity to study the effectiveness of booster seats in real-world settings. To date, results of booster seat effectiveness compared with seat-belt-only use has demonstrated mixed findings. Methods We used Alberta police collision report data from 2010-2016. The study population includes all motor vehicle collisions involving at least one 4-8-year-old. Using a case-control study design, children who were reported by police to be injured (cases) were compared with those uninjured (controls) for booster seat use. Logistic regression was used to estimate the association between booster seat use and injury. Results There were 12,922 children involved in a collision, resulting in 673 child injuries. There were 793 children in the front seat excluded from analysis. Unadjusted analyses indicate that compared with booster seat users, there were greater odds of injury for seat-belt users (OR=1.21; 95% CI: 1.02–1.44) and those not using any restraints (OR= 8.16; 95% CI: 4.66–14.31). When stratifying by impact and collision types, front-end vehicle-on-vehicle collisions demonstrated greater odds of injury for seat-belt wearers relative to those in booster seats (OR= 1.51 95% CI: 1.10–2.08). Conclusion Crude analyses indicate a protective effect of booster seats compared with seat-belts, depending on the type of collision and impact location. Learning Outcomes These regionally-specific injury data may help inform policy on the use of booster seats. Stratification by collision impact location may be necessary to inform analyses on booster seat effectiveness.

Background Motor-vehicle collisions are a leading cause of child bicyclist and pedestrian injuries in Canada. Injury occurrence and severity are associated with vehicle speeds but may be moderated through traffic calming. As a third of child bicyclist and pedestrian injuries occur within 300 meters of schools, it is important to focus interventions at these locations. This study will compare the effect of two traffic calming measures (i.e., in-street signs and traffic-calming-curbs) around elementary (K-Gr8) schools in Calgary. Methods Using a stepped-wedge cluster randomized controlled trial, 70 eligible elementary schools will be randomly assigned one traffic calming intervention, installed between April and August 2020. Traffic speed and volume (pneumatic tubes), and active transportation prevalence (observational counts), will be collected one week before and one week after intervention installation. Change in outcomes between pre- and post-intervention will be compared within schools for each intervention type. Post-intervention data will also be compared with pre-intervention data from schools yet to receive the intervention. Analyses will include generalized linear mixed effects models. Results Reductions in vehicle speeds are expected for both traffic calming features. Smaller changes in traffic volume and active transportation are expected across all traffic calming features. Greater effects are expected from traffic-calming-curbs. Discussion Scientific evidence on traffic calming intervention effectiveness may improve municipal decision-making, standards for new construction, prioritization of interventions in other jurisdictions, and inform further study in non-school environments. This study is a partnership between the City of Calgary and the University of Calgary.

Background Motor vehicle collision is a leading cause of injury and mortality in teens. Graduated drivers licensing (GDL) is a common practice to help mitigate risk associated with younger and inexperienced drivers. However, gaps and inconsistencies exist across regions in how restrictive GDL rules are. Methods This study used police collision report data from Alberta, Canada for the years 2010–2016. An automated, previously validated, culpability analysis tool was applied to collisions involving drivers between 16 and 19 years of age to score fault. Factors that increase odds of fault in all-collisions were identified using logistic regression. Results There were 45,938 motor vehicle collisions involving young drivers. of these, approximately 71% of young drivers were identified as at-fault. Crude analyses indicate that driving between 2300 hrs and 600 hrs increase odds of being at-fault (OR= 1.39; 95% CI: 1.27–1.51). Odds of being at-fault in collision were lower with the presence of an adult passenger over 20 years of age (OR= 0.62; 95% CI: 0.57–0.67) or a single peer of similar age (OR= 0.90; 95% CI: 0.83–0.97). Other passenger categories (younger passenger or multiple teens) were not significantly associated with young driver culpability. Conclusion Passenger type and time of day may both be contributing to young driver fault in collisions. Future directions include multivariable analysis as well as analysis on teen driver fault in severe injury collisions. Learning Outcomes There exists a potential opportunity for policy regulations that may modify or reduce exposure to factors contributing to teen driver culpability in motor vehicle collisions.

Background Toronto introduced a Vision Zero Road Safety Plan (RSP) in 2017 with a goal of eliminating road traffic fatalities and serious injuries by 2021. A series of policies were published alongside the RSP with a focus on pedestrians, school children, and cyclists. While these documents provide insight into plans for future interventions targeted at vulnerable road users, little is known about the types of interventions that are most frequently recommended by policymakers and whether they are effective at reducing injuries. Objective The purpose of this study was to identify and categorize the types of interventions outlined in city plans and/or policies directly related to traffic safety in Toronto, Canada. Methods We performed an environmental scan of policies/plans that outline interventions such as regulatory changes and awareness campaigns with a focus on road traffic safety. Results Our search yielded 26 policies with a purpose/objective statement on topics including the built environment, urban design, and active school transportation. Almost half (46%) were identified as being directly related to road traffic safety and were further summarized by intervention type, target population, cost, and whether the intervention was outlined in Toronto’s Vision Zero RSP. A total of 107 interventions were identified in policy documents in Toronto. Forty three percent of interventions recommended modifications to the built environment (e.g. traffic calming measures). Interventions requiring a reduced speed limit from 50 km/h to 40 or 30 km/h were mentioned in 58% of policy documents in Toronto. Conclusions Most interventions outlined in road safety policy documents in Toronto align with Vision Zero. Having identified the policies/plans that are recommended most often for implementation, these results will be used to prioritize naturalistic (quasi-experimental) research studies that demonstrate the effectiveness of specific interventions (e.g. speed limit reductions). Future studies will examine inter-municipal policy comparisons between Canadian provinces.

Background Road traffic injury is the leading cause of death for children in Canada. Lower speed roads are correlated with lower pedestrian injury severity. Pedestrians are 8 times more likely to die after being struck by a motor vehicle going 50 km/h compared with 30 km/h. Few studies have examined the effect of speed limit reductions on vulnerable road users such as bicyclists or pedestrians. Given the recent increase in the number of pedestrian motor vehicle collisions (PMVC) in Toronto, it is important to describe the effectiveness of interventions such as speed limit reductions. Objective To examine the effect of lowering residential speed limits to 30 km/h on police reported child PMVCs in Toronto, Canada between 2014 and 2018. Methods We will investigate the influence of implementing 30 km/h speed limits on 387 km of residential streets that occurred in January 2015. We will calculate the number of police reported child PMVC per km per month along these streets for two years before and two years after the speed limit change. We will use comparator streets with a constant 40 or 50 km/h limit to isolate the effect of the intervention from that of secular trends, controlling for other built environment characteristics (e.g., speed humps, pedestrian crossovers). Expected findings We hypothesize that the rate of PMVC will decrease after the implementation of 30 km/h speed limits. pedestrian safety, including speed limit reductions. It is important to evaluate and quantify the effect of these changes on child pedestrian injury rates. Policy implications Results may provide evidence to support the implementation of speed reductions to make our roads safer.

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 Ice hockey is Canada’s most popular winter sport. We have previously demonstrated that injury and concussion risk is reduced >60% in 11–12 year-old players where body checking was disallowed in games nationally in Canada in 2013. Objective: To evaluate the risk of injury and concussion associated with policy change disallowing body checking in games in non-elite Bantam (ages 13–14) ice hockey leagues, compared to body checking leagues. Methods This is a cohort study. Bantam players were recruited from non-elite Bantam teams where policy allowed body checking and following policy change where policy disallowed body checking (2014–2016). A validated injury surveillance system was used to collect preseason, exposure, and injury data. All ice hockey injuries were identified by a team safety designate. Any player with a suspected concussion was referred to a study sport medicine physician. Multivariable Poisson regression analyses controlled for relative age, previous injury, and clustering by team (offset by exposure hours). Findings Forty-nine body checking teams (608 players) and 33 teams non-body checking teams (396 players) participated. There were 123 game injuries [incidence rate (IR)=7.61/1000 hours] and 53 game concussions (IR=3.28/1000 hours). After policy change, there were 27 game injuries (IR=3.19/1000 hours) and 14 game concussions (IR=1.65/hours). Policy disallowing body checking was associated with a reduced rate of all injury [incidence rate ratio (IRR)=0.36 (95% CI; 0.21–0.61)], injury (time-loss >7 days) [IRR=0.35 (95% CI; 0.2–0.62)], concussion [IRR=0.43 (95% CI; 0.21–0.88)], and concussion (time-loss >10 days) [IRR=0.4 (95% CI; 0.18–0.87)]. Conclusion Policy change disallowing body checking in non-elite Bantam ice hockey resulted in a 64% reduction in injury and 57% reduction in concussion rate. Policy implications These findings have important implications for sport policy change informing a reduction in the public health burden of injury.

Background The number of child pedestrians killed or seriously injured on Canada’s roadways increases annually. One third of individuals who die on the roads are children. Research has focused on trying to change the behaviour of children who cross the road; this approach is not effective and can lead to victim blaming. Identifying characteristics of drivers who collide with pedestrians (pedestrian motor vehicle crashes-PMVC) and built environment (BE) risk factors can potentially influence policies that affect drivers and infrastructure; creating safer walking spaces for children. Objective To examine the characteristics of 1) drivers involved in a child PMVC in Calgary or Edmonton, Alberta; 2) the BE in which child PMVC occur. Methods Using police reported traffic collisions, we will examine characteristics of motorists involved in child PMVCs. These motorist’s characteristics will be compared with motorists who were involved in a collision with at least one other vehicle, but were assessed to be not at fault. This ‘not at fault’ control group will represent the source population of all motorists allowing us to highlight differences in driver and built environment characteristics between them and the drivers involved in PMVC. Expected findings We hypothesize that the characteristics of drivers who hit a child pedestrian (i.e. behaviour, driver action) and the BE will significantly differ from the control population of non-culpable drivers. Conclusion Expecting children to behave ‘appropriately’ on the road is unrealistic and trying to modify their behaviour with pedestrian training programs is ineffective. A more promising strategy to prevent PMVC relates to policies affecting drivers (e.g., distracted driving laws, speed limit reductions) and BE modification (e.g., traffic calming strategies). Policy implications This innovative study will provide information that can be used to create conditions for safer walking for children and youth potentially leading to better long- term population health.