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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.

Background: Intensive sport participation in childhood and adolescence is an established cause of acute and overuse injury. Interventions and programs designed to prevent such injuries are important in reducing individual and societal costs associated with treatment and recovery. Likewise, they help to maintain the accrual of positive outcomes from participation, such as cardiovascular health and skill development. To date, several studies have individually tested the effectiveness of injury prevention programs (IPPs). Purpose: To determine the overall efficacy of structured multifaceted IPPs containing a combination of warm-up, neuromuscular strength, or proprioception training, targeting injury reduction rates according to risk exposure time in adolescent team sport contexts. Study Design: Systematic review and meta-analysis. Methods: With established inclusion criteria, studies were searched in the following databases: Cochrane Central Register of Controlled Trials, MEDLINE, SPORTDiscus, Web of Science, EMBASE, CINAHL, and AusSportMed. The keyword search terms (including derivations) included the following: adolescents, sports, athletic injuries, prevention/warm-up programs. Eligible studies were then pooled for meta-analysis with an invariance random-effects model, with injury rate ratio (IRR) as the primary outcome. Heterogeneity among studies and publication bias were tested, and subgroup analysis examined heterogeneity sources. Results: Across 10 studies, including 9 randomized controlled trials, a pooled overall point estimate yielded an IRR of 0.60 (95% CI = 0.48-0.75; a 40% reduction) while accounting for hours of risk exposure. Publication bias assessment suggested an 8% reduction in the estimate (IRR = 0.68, 95% CI = 0.54-0.84), and the prediction interval intimated that any study estimate could still fall between 0.33 and 1.48. Subgroup analyses identified no significant moderators, although possible influences may have been masked because of data constraints. Conclusion: Compared with normative practices or control, IPPs significantly reduced IRRs in adolescent team sport contexts. The underlying explanations for IPP efficacy remain to be accurately identified, although they potentially relate to IPP content and improvements in muscular strength, proprioceptive balance, and flexibility. Clinical Relevance: Clinical practitioners (eg, orthopaedics, physical therapists) and sports practitioners (eg, strength and conditioners, coaches) can respectively recommend and implement IPPs similar to those examined to help reduce injury rates in adolescent team sports contexts.

Background The FIFA 11+ program is efficacious in preventing lower extremity injuries in youth soccer players; however, its implementation remains a challenge. Coaches9 beliefs and actions regarding injury prevention may influence program implementation. Objective To describe baseline psychosocial factors and evaluate their relationship with intended FIFA 11+ implementation amongst youth soccer coaches, using the Health Action Process Approach (HAPA) behaviour change model. Design Cross-sectional study. Setting Community youth soccer. Participants Seventy-nine youth soccer coaches from across Canada who attended a FIFA 11+ workshop (Spring 2016) during a nationwide program implementation initiative. Assessment of Risk Factors A HAPA-based questionnaire was used to measure risk perceptions (RP), outcome expectancies (OE) and task self-efficacy (TSE) on a 7-point Likert scale. Scale levels were combined (positive, negative and neutral) to describe baseline values. Spearman correlation was used to assess relationship between factors and intention (INT) (with Bonferroni correction). Main Outcome Measurements INT to implement the FIFA 11+ in the successive soccer season as measured by the questionnaire. Results In total, 92.4% of coaches completed the survey. Most coaches (84.6%) believed the overall risk of injury in youth soccer was high (RP). 80.6% of coaches believed soccer injuries were preventable (OE1) and 94.4% believed that the FIFA 11+ would decrease injury risk (OE2). 69.1% were confident in their understanding of the FIFA 11+ (TSE1) and 76.8% were confident in their ability to use it (TSE2). Most coaches (82.5%) intended to use the program (INT). Only TSE2 was found to be significantly associated with INT (r s =0.42, p=0.001). Conclusions This preliminary analysis demonstrates that task self-efficacy relating to youth soccer coaches9 confidence in being able to use the FIFA 11+ correlates positively with their intention to implement the program. No other significant relations were found between the other psychosocial factors and coaches9 intention.