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Background Mandatory bicycle helmet and booster seat laws for children are now common across Canada and the United States. Previous research has found that despite legislation, child compliance is often low. Our objectives were to identify and compare children's perspectives on barriers to and facilitators of their use of bicycle helmets and booster seats. Methods Eleven focus groups were conducted with a total of 76 children; five groups of children between the ages of 4 and 8 years discussed booster seats and bicycle helmets, and six groups of children between the ages of 9 and 13 years discussed bicycle helmets. Efforts were made to include diverse participants from a variety of ethno-cultural and socioeconomic backgrounds. Results Poor fit and physical discomfort were most often described as barriers to bicycle helmet use. Helmet appearance was a barrier for some children but acted as a facilitator for others. Booster seat facilitators included convenient features such as drink cup holders and being able to sit higher up in order to have a better view, while barriers included fear of being teased, and wanting to feel and be seen as more mature by wearing a seatbelt only. Conclusions The main barriers to usage of bicycle helmets and booster seats identified by young people were modifiable and fit within a theory of planned behaviour framework that includes subjective norms, child attitudes towards safety equipment and perceived behavioural control of its usage. Recommendations were made regarding how these elements can be utilized in future injury prevention campaigns.

Statement of purpose Previous research has identified a variety of risk and protective factors for injuries in school-aged children, including age, sex, number of siblings, and child risk taking behaviors. The goal of the present study was to go beyond these known risk factors and investigate if and how siblings influence the frequency and severity of childhood injuries. Methods/Approach Seventy-nine families with two school-aged children aged seven and ten years old on average were recruited from the community; 54% were female. Parents were 38 years old on average and self-identified as multiracial (8%), Indigenous (18%), and European-Canadian (75%); 92% were female. Parents reported on the frequency of minor and medically-attended child injuries within the past three months. They also reported on child risk-taking behavior and sibling supervision. Children reported on warmth and hostility in their sibling relationships. Results Larger sibling spacing but not number of siblings was significantly associated with more minor injuries for younger siblings. Boys with older brothers experienced significantly more medically-attended injuries than boys or girls with older sisters. Greater risk taking was related to significantly more minor injuries for both younger and older siblings. Younger but not older sibling minor injuries were negatively related to sibling warmth and positively related to sibling hostility. Sibling supervision was not associated with injury frequency or severity, but was negatively related to warmth reported by both younger and older siblings. Conclusions In addition to well-known demographic characteristics, siblings played an influential role in both elevating and mitigating injury risk for school-aged children, with older siblings having a greater influence on safety. Significance Siblings are often not taken into account in injury research, their influence on child safety is understudied. The present study highlighted some of the important aspects of sibling influence that could inform future injury prevention programs.

Background While family size and sibling supervision have both been shown to influence child injury risk, the role of sibling relationship quality in child injury has not been investigated. Our goal was to investigate potential linkages between child injuries and the quality of sibling relationships. Methods Seventy-nine families with two school-aged children aged seven and ten years on average were recruited from the community; 54% were female. Children reported on the quality of their sibling relationships and parents reported on the frequency of minor child injuries within the past three months, as well as their supervision attitudes. Results Younger siblings in antagonistic relationships characterized by high hostility and low warmth incurred significantly more minor injuries; this was especially the case when age spacing between siblings was larger. Higher parental confidence in younger siblings was significantly related to fewer minor injuries for older, but not younger siblings. Conclusions Sibling relationship quality played a significant role in injury risk for school-aged children, particularly when sibling age spacing was larger. Therefore, the quality of sibling relationships should be taken into account in future research, as well as in home injury prevention programs. Parental confidence in younger siblings was linked to fewer older sibling injuries, underlining the importance of understanding the interconnected nature of family dynamics on child injury. Learning Outcomes Antagonistic sibling relationships were significantly associated with more minor injuries for younger siblings, especially when sibling age spacing was larger. Parental confidence in younger siblings was related to fewer older sibling minor injuries.

To date, little work has compared similarities and differences between parent and young people's perceptions of barriers to and facilitators of bicycle helmet and booster seat usage. Our goal was to conduct such a comparison in order to inform future safety campaigns. Eleven focus groups with a total of 68 parents and 11 focus groups with a total of 76 young people were conducted. Recruitment was conducted and focus groups were held in diverse neighbourhoods to facilitate participation by families from a variety of cultural, linguistic, and socioeconomic backgrounds. Overall, parents and their children agreed on 50% of the barriers identified for bicycle helmet use and approximately 40% of the barriers for booster seats. Barriers common to both types of equipment for parents and children included comfort, style and design, and fear of teasing. Common facilitators included perceived safety, and comfort. While there was considerable overlap between the perspectives of parents and young people, there were also differences, underscoring the importance of addressing both perspectives. The barriers and facilitators identified were modifiable to a large extent; based on these, recommendations for future injury prevention campaigns were outlined.

Objective The Manitoba Infant Feeding Database (MIFD) is being piloted as a surveillance system leveraging infant vaccination visits as a point of contact to collect infant feeding data during the first year of life. The objective of this study was to assess data quality and acceptability of the MIFD as a sustainable population-based surveillance system. Methods Internal completeness and internal validity were measured to assess data quality. Internal completeness was defined as the number of completed data fields out of the total number of data fields. Internal validity was defined as the proportion of translation errors from one level of the system, the paper questionnaire, to the next, the electronic database. A survey assessed staff’s acceptance of data collection and submission processes. Results A total of 947 records were reviewed. Data were 98.5% complete. Discrepancies were noted in 13.5% of data. The survey response rate was 78.4%. Nearly all respondents reported that the MIFD data collection tool was easy to use (96.6% agreed or strongly agreed). Whereas some challenges were identified, the majority were willing to continue with the MIFD data collection tool and process (93.1%). Conclusion Results from this evaluation suggest that the MIFD data collection process worked well; however, data validation will require human resources. The MIFD approach provides a sustainable mechanism for collecting data on infant feeding for surveillance and research purposes.

IntroductionBreast feeding is associated with many health benefits for mothers and infants. But despite extensive public health efforts to promote breast feeding, many mothers do not achieve their own breastfeeding goals; and, inequities in breastfeeding rates persist between high and low-income mother–infant dyads. Developing targeted programme to support breastfeeding dyads and reduce inequities between mothers of different socioeconomic status are a priority for public health practitioners and health policy decision-makers; however, many jurisdictions lack the timely and comprehensive population-level data on infant-feeding practices required to monitor trends in breastfeeding initiation and duration. This protocol describes the establishment of a population-based infant-feeding database in the Canadian province of Manitoba, providing opportunities to develop and evaluate breastfeeding support programme.Methods and analysisRoutinely collected administrative health data on mothers’ infant-feeding practices will be captured during regular vaccination visits using the Teleform fax tool, which converts handwritten information to an electronic format. The infant-feeding data will be linked to the Manitoba Population Research Data Repository, a comprehensive collection of population-based information spanning health, education and social services domains. The linkage will allow us to answer research questions about infant-feeding practices and to evaluate how effective current initiatives promoting breast feeding are.Ethics and disseminationApprovals have been granted by the Health Research Ethics Board at the University of Manitoba. Our integrative knowledge translation approach will involve disseminating findings through government and community briefings, presenting at academic conferences and publishing in scientific journals.

Background The study was designed to determine if youth

Motor vehicle collisions and bicycle collisions and falls are a leading cause of death by preventable injury for children. In order to design, implement and evaluate campaigns and programs aimed at improving child safety, accurate surveillance is needed. This paper examined the challenges that confront efforts to collect surveillance data relevant to child traffic safety, including observation, interview, and focus group methods. Strategies to address key challenges in order to improve the efficiency and accuracy of surveillance methods were recommended. The potential for new technology to enhance existing surveillance methods was also explored.

Automobile crashes are the leading cause of death in children aged 1-14 years. Many children, however, are not properly restrained in safety seats that reduce serious injury and death. This study used a discrete choice conjoint experiment to study factors influencing the decision to use booster seats. Parents of 1714 children aged 4-9 years from nine Canadian provinces completed choice tasks presenting experimentally varied combinations of 15 4-level booster seat promotion attributes. Latent class analysis yielded three segments of parents. The choices of the Benefit Sensitive segment (50%) were most sensitive to the injury prevention benefits of booster seats. The choices of parents in the Context Sensitive segment (33.5%) were more likely to be influenced by installation complexity, oppositional behavior, and the prospect that their child may be teased for riding in booster seats. Parents in the High Risk segment (16.5%) were younger, less educated, and less knowledgeable about vehicle safety legislation. They anticipated fewer benefits, expected more barriers and were less likely to use booster seats. Simulations suggest that consistent enforcement coupled with advertising focusing on injury prevention and the use of booster seats by other parents would increase adoption.

OBJECTIVE: To develop a set of national injury indicators for Canadian children and youth which will eventually be used to reflect and monitor identified prevention priorities. METHODS: The Canadian Injury Indicators Development Team brought together injury researchers, policy makers, and practitioners to develop injury indicators in the following areas: overall health services implications; motor vehicle occupant; sports, recreation, and leisure; violence; and trauma care, quality, and outcomes. A modified-Delphi process was used to establish a set of indicators that met evidence-based criteria, were useful, and that would prompt action. Each indicator was rated by 132 respondent injury experts and stakeholders on its usefulness and ability to prompt action to reduce injury among Canadian children and youth. RESULTS: From an initial list of 51 indicators, a refined set of 34 indicators was established. Indicators were grouped into three categories related to: policies; risk and protective factors; and outcomes. Indicators related to motor vehicle injury were rated as most useful and most able to prompt action. Injury mortality rate and injury hospitalisation rate were also rated highly for both usefulness and ability to prompt action. Policy, violence, sport and recreation, and trauma indicators were all rated higher for usefulness, but somewhat lower for ability to prompt action. CONCLUSION: Results suggest that a broad-based modified-Delphi process is an important first step in developing useful and relevant indicators for injury prevention activity focused on Canadian children and youth. Language: en

These are commentaries on a Cochrane review, published in this issue of EBCH, first published as: Macpherson A, Spinks A. Bicycle helmet legislation for the uptake of helmet use and prevention of head injuries. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD005401. DOI: 10.1002/14651858.CD005401.pub2. Further information for this Cochrane review is available in this issue of EBCH in the accompanying EBCH Summary article. Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. The Cochrane Collaboration

Injury surveillance systems are used to describe the burden of injuries, to document specific patterns of injuries, to identify emerging hazards, and to evaluate the effectiveness of prevention strategies. Pediatric emergency medicine practitioners use and participate in injury surveillance systems. The purpose of this article is to review the principles of injury surveillance as applied to pediatric emergency medicine, to highlight the roles and responsibilities of practitioners in injury surveillance, and to provide opportunities for readers to explore current data and injury surveillance systems using online resources and examples from the literature.

Objective—To evaluate and summarize the house fire injury prevention literature. Methods—MEDLINE (1983 to March 1997) was searched by keyword: fire, burn, etiology, cause, prevention, epidemiology, and smoke detector/alarm. ERIC (1966 to March 1997) and PSYCLIT (1974 to June 1997) were searched by keyword: as above, and safety, skills, education, and training. Other sources included references of retrieved publications, review articles, and books; Injury Prevention hand search; government documents; and internet sources. Sources relevant to residential fire injury prevention were selected, evaluated, and summarized. Results—Forty three publications were selected for review, including seven randomized controlled trials, nine quasiexperiments, two natural experiments, 21 prospective cohort studies, two cross sectional surveys, one case report, and one program evaluation. These studies examined the following types of interventions: school (9), preschool (1), and community based educational programs (5); fire response training programs for children (7), blind adolescents (2), and mentally retarded adults (5) and children (1); office based counseling (4); home inspection programs (3); smoke detector giveaway campaigns (5); and smoke detector legislation (1). Conclusions—This review of house fire prevention interventions underscores the importance of program evaluation. There is a need for more rigorous evaluation of educational programs, particularly those targeted at schools. An evidence based, coordinated approach to house fire injury prevention is critical, given current financial constraints and the potential for program overload for communities and schools.

Objectives—To describe the patterns of protective equipment use by in-line skaters in Winnipeg, Manitoba and nearby rural communities. Methods—In-line skaters were observed for three months in 1996 at 190 urban and 30 rural sites selected using a formal sampling scheme. Age, gender, protective equipment use, skating companions, correct helmet use, and use of headphones were recorded. Results—Altogether 123 in-line skaters were observed at 61 sites, including one rural site. No skaters were observed at the remaining sites. There were 37 adults and 86 children; 56% were male. Helmet use was 12.2% (95% confidence interval (CI ) = 6.4% to 18.0%), wrist guard use was 16.3% (95% CI = 9.7% to 22.8%), knee pad use was 9.8% (95% CI = 5.2% to 16.4%), and elbow pad use was 7.3% (95% CI = 3.4% to 13.4%). Children were more likely to wear a helmet than teens 12‐19 years of age (relative risk (RR) = 30, 95% CI = 4.01 to 225).Adults were more likely to wear wrist guards than children (RR = 4.32, 95% CI = 1.87 to 9.94). No gender diVerences were found. Incorrect helmet use was documented in four skaters; three skaters were wearing headphones. Conclusions—Low rates of protective equipment use were documented in our region, significantly lower than those reported in the literature. Barriers to equipment use are not known, and should be examined by further study. In-line skating safety programs should be developed, promoted, and evaluated. Teens should be targeted for future preventive eVorts. (Injury Prevention 1998;4:198‐202)

Objectives—To describe all terrain vehicle (ATV) ownership, access, use, and safety behaviours in rural Manitoba children. Methods—Questionnaire administered to a convenience sample of grade 6 students attending an agricultural fair. Results—162 grade 6 children participated. The mean age was 11.4 years, and 46% were male. 125 students (77%) reported having access to ATVs, including 69 four wheeled, 24 three wheeled, and four both three and four wheeled ATVs. ATV experience was reported in 95 students, significantly more often in males and among those with a family owned ATV, with no difference between children living on a farm and in a town. Use of helmets and protective clothing was inadequate (10–40%), and dangerous riding habits common, with males and children living on a farm reporting significantly fewer desirable behaviours. Conclusions—ATVs are commonly used by children in rural Manitoba, with inadequate protective gear and dangerous riding habits. Mandatory rider training, consumer and dealer education, and legislation enforcement could improve ATV safety in this population.

The majority of child and youth injuries are preventable. This statement provides background, direction and a statement of commitment to the issue of child and youth injury prevention in Canada. It acts as a foundation to build upon by focusing first on definitions, scope and priorities for injury prevention. It also describes the burden and patterns of unintentional injury, and the principles of effective intervention for prevention. A list of resources for obtaining data and evidence-based information is included in the full-text version of this statement (www.cps.ca). This statement can also be used for broad-based injury prevention advocacy.

La majorité des blessures dont sont victimes les enfants et les adolescents sont évitables. Le présent document de principes contient des renseignements généraux, des conseils et une déclaration d’engagement à l’égard de la prévention des blessures au Canada. Il sert de base sur laquelle construire en s’attardant d’abord aux définitions, à l’étendue et aux priorités en matière de prévention des blessures. Il contient également une description du fardeau et du profil des blessures non intentionnelles, de même que les principes d’interventions de prévention efficaces. La version intégrale renferme une liste de ressources en vue d’obtenir des données et de l’information probante (www.cps.ca). Enfin, le présent document de principes peut être utilisé pour la défense généralisée de la prévention des blessures.

Objective To examine the simultaneous contribution of multiple factors associated with parents9 use of booster seats. Methods Using the theory of planned behaviour framework, constructs of the theory were tested for usefulness in predicting self-reported intent and behaviour with respect to parents9 use of booster seats. Through the use of structural equation modelling, the study demonstrated the most significant predictors of the intent to use a booster seat and reported use of booster seats in a Canadian sample (n=1480) of parents of school-aged children, 4–9 years. Results The strongest predictors of intent to use booster seats were attitudes (benefits of booster seat use) and second, subjective norms (perceived booster seat use in the community). Parent barriers were inversely associated with intent and use of booster seats and child barriers with use. Intent and norms had the greatest effect on use, both positive and equally influential. The final model explains 30% of the variance in booster seat use. Conclusion Messages that address the benefit to the child in preventing injury could be beneficial if spread more diversely, establishing a social norm. Legislation, enforcement and local policy could positively influence the perceived culture that supports and expects booster seat use for school-aged children.

Drowning is the second leading cause of unintentional injury death for Canadian children up to 19 years of age. Specific regional drowning prevention strategies require a detailed understanding of patterns of injury, including risk factors. Paediatric death review committees have the opportunity to identify these risk factors, and to identify and advocate prevention strategies.The purpose of the present study was to analyze Manitoba Paediatric Death Review Committee (PDRC) drowning data to identify drowning risk factors and potential prevention strategies.A 10-year (1988-1997) review of the College of Physicians and Surgeons of Manitoba PDRC database was performed. Drowning deaths were summarized in terms of demographic variables and lack of supervision at the time of the drowning events.Seventy-three drowning deaths were reviewed by the PDRC during the study period. These children ranged from 29 days to 14 years of age. They included 50 boys and 30 First Nations children. The highest mortality rates were found in First Nations children (12.4/100,000 First Nations children compared with 1.9/100,000 non-First Nations children), boys (3.9/100,000 boys compared with 1.9/100,000 girls) and toddlers aged one to four years (5.9/100,000 children).Priority populations for drowning prevention in Manitoba include First Nations children, boys and toddlers. Death review committees can contribute to childhood injury prevention by reviewing injury deaths, analyzing and reporting injury mortality data, and identifying and advocating prevention strategies.

The National Fire Protection Association (NFPA) reported 402,000 residential fi res in 2003, resulting in 3,165 deaths and incurring $6,074,000,000 in property damage (Karter, 2004). This represented an increase of 17.4% in residential fi re deaths compared to 2002, although the overall number of fi res and property losses did not increase. Residential fi re deaths have been declining steadily since the late 1970s, with a relative plateau since the early 1990s. Smoking materials are the leading cause of fatal residential fi res (20%), with 40% of smoking-related fi re victims being older than 65 years of age (Hall, 2004). Cooking is the leading cause of residential fi res and nonfatal injuries (Hall, 2005). Despite 96% smoke alarm prevalence for U.S. homes with a telephone in 2004, 40% of residential fi res still occur in homes without a smoke alarm, and among homes with alarms, 25% are not functioning at the time of the fi re. In 1999–2001, an average of 70% of residential fi re deaths resulted from fi res in homes with either no smoke alarms or in which no smoke alarm sounded (Ahrens, 2004). Nearly every high-risk group for residential fi re fatality is less likely to install smoke alarms, including the poor, seniors, heavy drinkers, households with less than high school education, and those in rural areas and in the Southern United States (Ahrens, 2004; Hall, 1985; Hall, 1994). In 2002, for all ages combined, fi res and burns were the 6th leading cause of unintentional injury mortality, and the 14th leading cause of nonfatal injury (Centers for Disease Control and Prevention [CDC], 2005). Approximately 6% of people with residential fi re-related injuries are hospitalized, with slightly more than half being admitted for carbon monoxide poisoning and the remainder for burns (CDC, 2003). Children and older adults have the highest rates of fi re-related

OBJECTIVES To review the risks of injury to children in the hospital setting and to provide an overview of the factors which influence the approach to hospital safety, including institutional liability, hospital accreditation, patient safety and risk management issues. METHODS Fatal and nonfatal injuries to children in the hospital setting were identified using searches of the published literature and searches of incident, complaint and claims data sources, including regulatory agency databases, litigation and claims data, and medical device hazard databases. Canadian hospital law, accreditation, patient safety and risk management literature was reviewed and summarized. RESULTS Injuries occur in over 1% of hospitalized children, and are typically due to falls. Serious injuries are infrequent; however, a significant number of fatal injuries have been reported, mostly involving entrapment in beds and cribs, but also due to choking, strangulation and electrocution. Hospitals are liable for injuries to patients and visitors occurring on their premises. Canadian accreditation standards include provisions for the safety of equipment, supplies, medical devices and space, but do not provide specific guidance for children. Addressing injury hazards to children is an important aspect of the new patient safety movement, and falls within the scope of existing risk management and quality improvement programs. CONCLUSIONS Most hazards to children in the hospital setting can be easily corrected by proactively incorporating basic child safety principles. Paediatricians can play an important role in advocating for a safe hospital environment and should encourage administrators to consider child safety in routine hospital operation and policies.

Chez les enfants et les adolescents, le ski et la planche a neige sont des activites sportives populaires pour le loisir et la competition. Les blessures qui s’y associent sont courantes et peuvent etre graves. De nouvelles donnees probantes attestent des bienfaits du port du casque en ski et en planche a neige, et des donnees refutent les hypotheses selon lesquelles le port du casque accroitrait le risque de blessures au cou. Des donnees probantes appuient egalement le port de protege-poignets en planche a neige. Les mesures de prevention efficaces, telles que le port de materiel protecteur et les politiques connexes, sont peu mises en pratique. Les medecins devraient disposer de l’information necessaire pour conseiller les enfants, les adolescents et les familles au sujet de la participation plus securitaire aux sports d’hiver, y compris le port du casque, le port de protege-poignets en planche a neige, la formation et la supervision, l’importance d’avoir de l’equipement et des fixations bien ajustes, la prudence au soleil et la non-consommation de drogues ou d’alcool sur les pentes.

Skiing and snowboarding are popular recreational and competitive sport activities for children and youth. Injuries associated with both activities are frequent and can be serious. There is new evidence documenting the benefit of wearing helmets while skiing and snowboarding, as well as data refuting suggestions that helmet use may increase the risk of neck injury. There is also evidence to support using wrist guards while snowboarding. There is poor uptake of effective preventive measures such as protective equipment use and related policy. Physicians should have the information required to counsel children, youth and families regarding safer snow sport participation, including helmet use, wearing wrist guards for snowboarding, training and supervision, the importance of proper equipment fitting and binding adjustment, sun safety and avoiding substance use while on the slopes.

Objectives—To document current bicycle helmet use in Winnipeg, Manitoba and nearby rural communities, and to identify target groups for a helmet promotion campaign. Methods—Cyclist helmet use was observed between 28 May and 20 August 1996 at a sample of urban and rural locations. Age, gender, helmet use, riding companion(s), location type, correct helmet use, and use of headphones were recorded. Univariate and multivariate analyses were performed. Adjusted odds ratios with 95% confidence intervals were calculated from the final models. Results—Altogether 2629 cyclists (70% male, 30% female) were observed: 2316 at 183 urban locations and 313 at 25 rural locations, with nearly equal numbers of children and adults observed. Overall helmet use was 21.3%, with lower use in males (18.9%) than females (26.3%), despite gender only being a significant variable on multivariate analysis for children under 8 years and adults. Urban helmet use was considerably higher (22.9%) than rural use (8.9%). Helmet use increased linearly as mean neighbourhood income increased, with a nearly fourfold diVerence in use between the highest and lowest income neighbourhoods. Children less than 8 years old and adults had the highest, and teenagers the lowest, use. Significant predictive variables were identified separately by age category to inform targeted programming. Conclusions—We documented low helmet use in our region, emphasizing the need for a regional helmet promotion campaign as well as future helmet legislation. A marked urban-rural diVerence in helmet use that has not been previously reported was also identified. Target groups for a future campaign include adolescents,males,rural cyclists,and those in lower income neighbourhoods. (Injury Prevention 1999;5:183‐188)

Objective —To summarize house fire injury risk factor data, using relative risk estimation as a uniform method of comparison. Methods —Residential fire risk factor studies were identified as follows: MEDLINE (1983 to March 1997) was searched using the keywords fire*/burn*, with etiology/cause*, prevention, epidemiology, and smoke detector* or alarm*. ERIC (1966 to March 1997) and PSYCLIT (1974 to June 1997) were searched by the above keywords, as well as safety, skills, education, and training. Other sources included: references of retrieved publications, review articles, and injury prevention books; Injury Prevention journal hand search; government documents; and internet sources. When not provided by the authors, relative risk (RR), odds ratio, and standardized mortality ratios were calculated, to enhance comparison between studies. Results —Fifteen relevant articles were retrieved, including two case-control studies. Non-modifiable risk factors included young age (RR 1.8–7.5), old age (RR 2.6–3.6), male gender (RR 1.4–2.9), non-white race (RR 1.3–15.0), low income (RR 3.4), disability (RR 2.5–6.5), and late night/early morning occurrence (RR 4.1). Modifiable risk factors included place of residence (RR 2.1–4.2), type of residence (RR 1.7–10.5), smoking (RR 1.5 to 7.7), and alcohol use (RR 0.7–7.5). Mobile homes and homes with fewer safety features, such as a smoke detector or a telephone, presented a higher risk of fatal injury. Conclusions —Risk factor data should be used to assist in the development, targeting, and evaluation of preventive strategies. Development of a series of quantitative systematic reviews could synthesize existing data in areas such as house fire injury prevention.

Objectives The goal of the present study was to explore developmental differences in the nature of typical supervision by family members from infancy to adolescence. Methods A phone survey was conducted in Winnipeg Manitoba Canada. Qualifying respondents were parents of a child up to 17 years of age living in the home. Parents were questioned about their typical supervision behaviours (ie, checking on their child) as well as whether a specific injury event occurred within the past 12 months. Results Four hundred respondents were interviewed; of these, 88% reported having a child who sustained an injury within the past 12 months. Examination of injury cases indicated significant developmental differences in typical parent supervision style across age. Parents were most vigilant in their supervision of the youngest children (under age 4) and school-aged children (aged 5–11), reporting seeing and hearing them virtually all of the time (98%). However, parents were significantly more likely to report indirect supervision strategies such as checking occasionally for children aged 12 years and older. Interestingly, supervision by siblings also showed clear developmental trends; sibling supervision was most likely to occur for shorter periods of time (1–4 h) with children aged 12–14 years. A small minority of families (4%) reported using sibling supervision for children under the age of 12. Conclusions There were significant differences in typical family supervision style as a function of child age. Findings suggest supervision style is a modifiable risk factor which may inform future injury prevention strategies.

School aged children in Canada are ten times more likely than any other age groups to experience death or severe injury in road crashes. Misuse of safety seats and lack of booster seat use are primarily responsible for these high rates of automobile death and injury. National surveys of booster seat use have noted regional differences; however, research on influences for usage is limited. This study examined influences on parents decision making for booster seat use in two Canadian provinces; British Columbia and Manitoba. British Columbia has recently legislated use of booster seats while Manitoba has not. Although parents in both provinces did not differ on the perceived safety benefits of using booster seats they did significantly differ on their intent to use them. Parents in British Columbia were significantly more likely to report they would always make sure their child rode in a booster seat. Parents perception of barriers to using booster seats did not differ significantly with one exception; Manitoba parents were more likely to perceive that children were teased for riding in booster seats. British Columbian parents reported significantly higher exposure to multi media messaging about booster seats and knew booster seats were legally required for children under 9 years of age. In contrast, Manitoba parents were confused regarding whether their province had booster seat legislation and had less exposure to messaging about booster seat safety. The results suggest that legislation and knowledge of the legislation for booster seat use may impact usage within Canada.

Introduction: Socio-economic inequalities in child health have been documented post-Medicare (1971) in Canada. Although it is assumed that the introduction of Medicare reduced these inequalities, comparable pre-Medicare data are lacking. Therefore we investigated infant mortality using income quintile analysis. We also explored potential explanatory variables reflecting pre-Medicare social conditions. Methods: Census division infant mortality data for 1950-52 and 1962-64 and corresponding income data were obtained. Statistics Canada definitions of low income were used to determine the percentage of low income families in each census division. For each study period, divisions were ranked by percentage of low income families and divided into income quintiles. Infant, neonatal and postneonatal mortality rates (IMR, NMR, PNMR) were determined for each quintile. Multiple regression analyses were performed with the following explanatory variables: percentage low income and average annual income(separate analyses); percentage of occupied dwellings with no installed bath facilities, no running water and no refrigeration facilities; and percentage having a TV and having a car. Results: 206 (1950-52) and 208(1962-64) census divisions from 8 provinces were included. Although infant mortality rates declined significantly between the two study periods, relative infant mortality did not change. The ratio Q5:Q1 (highest percentage low income vs lowest) was 1.62 in 1950-52 (95% CI 1.57-1.67) and 1.57 in 1962-64(95% CI 1.51-1.63). Multiple regression analyses showed that having a TV (IMR, PNMR), having a car (IMR,PNMR), and not having installed bath facilities(IMR,NMR,PNMR) were better predictors of infant mortality than income measures. Discussion: Infant mortality inequalities persisted after Medicare: a study of census metropolitan areas documented relative infant mortality of 1.97 in 1971 and 1.82 in 1986 (lowest compared to highest income quintile,Wilkins 1986). Our results suggest that improvements in access to medical care benefited children both in poor and wealthy areas of Canada. Alternatively, inequitable access may still exist. The limitations of medical care in reducing inequalities in health status are well known; social policy addressing the issue of child poverty may be required to achieve greater equity.