Beth S. Bruce

Are we there yet? Canada's progress towards achieving road safety vision 2010 for children travelling in vehicles

This study examines safety seat use among Canadian children and evaluates child safety seat use relative to the national policy for child occupant safety, Road Safety Vision 2010. Using a probability sample, roadside observations of car safety seat use were collected from May to October of 2006 for 13,500 children aged from birth to 9 years in 10,084 vehicles at 182 sites in nine Canadian provinces and one territory. Observations revealed that 89.9% of Canadian children were restrained in some type of restraint. However, only 60.5% of these children were restrained in the correct safety seat. When comparing rates of correct use across provinces, results were not significantly different in provinces with booster seat legislation and those without this legislation. This data may be useful for healthcare practitioners and policy makers to develop interventions aimed at increasing appropriate car safety seat use for children in Canada.

School Experiences of Families of Children With Brain Tumors

Families and children often report a diverse range of academic achievements and challenges after undergoing treatment for a brain tumor. This study explores the experiences of children, youth, and their families as they seek to reintegrate into mainstream educational systems. Despite the variable experiences, there are many common strategies that could positively influence the childs success in school. Strong communication between parents, school, and health professionals is paramount. Preparing parents to advocate for their childrens academic and social needs and developing an awareness of the challenges among school staff has potential to improve outcomes for these children. Equipping the children with the social skills needed to manage social situations will strengthen their ability to overcome the challenges that they face. These study findings shed light on the academic experiences of these children and can lead to the development of strategies to support families facing similar challenges.

School Liaison Program for Children With Brain Tumors

A school liaison program that familiarized teachers with the implications of each child’s brain tumor treatment with respect to learning, behavior, and socialization was implemented. The study explored the experiences of nine families and their teachers and health staff who participated in the program. The successes and challenges of the program were captured through interviews that were audio-taped and transcribed verbatim for data analysis. Individualized programs were negotiated between families and education staff to address behavioral, academic, and social needs of each child. Children were able to learn to their ability rather than be judged on the achievements of their respective grade levels. Parents reported that the program strengthened their advocacy skills and improved the children’s social and learning achievements. Teachers reported an improved ability to provide more comprehensive educational programming suited to the child’s needs. Overall, most children in the program achieved or exceeded their initial academic, social, and behavioral expectations. The school liaison program demonstrated significant potential to enhance the learning experience for children with brain tumors.

Helmets for skiing and snowboarding: Who is using them and why

BACKGROUND In Canada, winter sports injuries are responsible for significant health care burden, with estimates of

Perceptions of risk among children with and without attention deficit/hyperactivity disorder

400 million in direct and indirect annual health care costs. For ski-related injuries, helmets have been shown to provide significant protection. Current common practice in Canada, including the Province of Nova Scotia, is to leave the decision of whether to wear a helmet to the individual. The purposes of this study were to document skiers’ and snowboarders’ use of helmets and to isolate factors associated with helmet use and nonuse. METHODS A mixed methods approach was used to collect data during a 2-month period at the province’s three ski hills. Naturalistic observations documented helmet use and falls, whereas interviews identified factors influencing helmet use or nonuse. RESULTS Helmets were used by most skiers (74%) and snowboarders (72%); the use varied significantly between ski hills, ranging from 69% to 79%. Females were more likely to wear helmets compare with males (80% vs. 70%). The highest rates of use were found among 4-year-old to 12-year-old children, with helmet use declining as age increases. Qualitative data revealed that helmet users were most influenced by the protective benefits of helmets (77%), personal choice (46%), family (44%), and rules (44%), while non–helmet users cited personal choice (29%), comfort (26%), rules (14%), and cost (11%) as reasons for nonuse. CONCLUSION More than 25% of skiers and snowboarders remain at increased risk of a serious brain injury by not wearing a helmet. Changes in regulations may be required to ensure widespread use of helmets on ski hills. LEVEL OF EVIDENCE Prognostic study, level II.

Scoping review of toolkits as a knowledge translation strategy in health

Traditionally, health professionals have positioned injury prevention strategies from their own perspective with little acknowledgement or understanding of the perspective of those who experience risk taking: specific populations of children with differing approaches to risk perception and problem-solving. The present study addresses this oversight by engaging children with and without attention deficit/hyperactivity disorder (ADHD) to explore the meaning of risk from their perspective. Although both groups of children reported similar processes of assessing risk, unique to children with ADHD was the overestimation of their physical abilities, intentional risk taking and anticipation of positive or no consequences of their risk taking. These findings also advance our knowledge of potentially appropriate strategies to effect change in risk taking that could influence risk of injury. Specifically, findings suggest that prevention efforts that incorporate both cognitive and social interventions are the most promising approaches. Integrating this understanding of childrens perception of risk builds our knowledge about the contribution of risk perception to injury events and may help to inform future injury prevention initiatives with children with ADHD.

Modeling improvements in booster seat use: a discrete choice conjoint experiment.

BackgroundSignificant resources are invested in the production of research knowledge with the ultimate objective of integrating research evidence into practice. Toolkits are becoming increasingly popular as a knowledge translation (KT) strategy for disseminating health information, to build awareness, inform, and change public and healthcare provider behavior. Toolkits communicate messages aimed at improving health and changing practice to diverse audiences, including healthcare practitioners, patients, community and health organizations, and policy makers. This scoping review explores the use of toolkits in health and healthcare.MethodsUsing Arksey and O’Malley’s scoping review framework, health-based toolkits were identified through a search of electronic databases and grey literature for relevant articles and toolkits published between 2004 and 2011. Two reviewers independently extracted data on toolkit topic, format, target audience, content, evidence underlying toolkit content, and evaluation of the toolkit as a KT strategy.ResultsAmong the 253 sources identified, 139 met initial inclusion criteria and 83 toolkits were included in the final sample. Fewer than half of the sources fully described the toolkit content and about 70% made some mention of the evidence underlying the content. Of 83 toolkits, only 31 (37%) had been evaluated at any level (27 toolkits were evaluated overall relative to their purpose or KT goal, and 4 toolkits evaluated the effectiveness of certain elements contained within them).ConclusionsToolkits used to disseminate health knowledge or support practice change often do not specify the evidence base from which they draw, and their effectiveness as a knowledge translation strategy is rarely assessed. To truly inform health and healthcare, toolkits should include comprehensive descriptions of their content, be explicit regarding content that is evidence-based, and include an evaluation of the their effectiveness as a KT strategy, addressing both clinical and implementation outcomes.

Achieving all-age helmet use compliance for snow sports: strategic use of education, legislation and enforcement

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.

Overestimation of Physical Abilities Among Boys With and Without ADHD

Background Nova Scotia is the first jurisdiction in the world to mandate ski and snowboard helmet use for all ages at ski hills in the province. This study represents a longitudinal examination of the effects of social marketing, educational campaigns and the introduction of helmet legislation on all-age snow sport helmet use in Nova Scotia. Methods A baseline observational study was conducted to establish the threshold of ski and snowboarding helmet use. Based on focus groups and interviews, a social marketing campaign was designed and implemented to address factors influencing helmet use. A prelegislation observational study assessed the effects of social marketing and educational promotion on helmet use. After all-age snow sport helmet legislation was enacted and enforced, a postlegislation observational study was conducted to determine helmet use prevalence. Results Baseline data revealed that 74% of skiers and snowboarders were using helmets, of which 80% were females and 70% were males. Helmet use was high in children (96%), but decreased with increasing age. Following educational and social marketing campaigns, overall helmet use increased to 90%. After helmet legislation was enacted, 100% compliance was observed at ski hills in Nova Scotia. Conclusions Results from this study demonstrate that a multifaceted approach, including education, legislation and enforcement, was effective in achieving full helmet compliance among all ages of skiers and snowboarders.

Promoting booster seat use for young children: A school-based intervention pilot study

Objective: Children with ADHD have been widely reported to overestimate their abilities in social and academic domains, but a similar overestimation of physical abilities has not been examined. Method: Twenty-four elementary school-age boys with ADHD and fifteen boys without ADHD were compared on their ability to accurately estimate their ability to complete four lab-based physical tasks, varying on three levels of difficulty: (a) within their ability, (b) 8% beyond their ability, and (c) 13% beyond their ability. Results: Children with ADHD were significantly more likely than controls to overestimate their physical ability at difficult levels of the task. Conclusion: Implications of these results for preventing risky behaviors in children with ADHD are discussed.