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Adolescents

Pondering the peanutabout…..

5 Jan, 17 | by Bridie Scott-Parker

I read the StreetsBlogUSA post Study: Diagonal Intersections are Especially Dangerous for Cyclists today with great interest, for a number of reasons that I thought I would share with you.

Firstly, there is no doubt that cyclists are a vulnerable road user group, and that particular segments of road are more problematic for cyclists. The research cited in the post pertains to an Injury Prevention publication which examined, in-depth, police reports of 300 car-cyclist crashes in the New York city area , and the police templates to record crash-pertinent information across the US. Innovative research which approaches a known problem from novel perspectives helps to provide additional pieces for the jigsaw puzzle that we seek to solve, and this research was an intriguing read indeed.

Secondly, the research revealed that some road configurations appeared to increase crash risk (i.e., we want to reconfigure these roads), and that the safest option in the most problematic circumstances was to separate the motor vehicle from the vulnerable cyclist. The ‘solution’ for cyclist safety can be a highly contentious issue, particularly here in Australia in which the motor vehicle has traditionally – through necessity – dominated our vast landscape, and as health and other benefits become apparent, cycling is gaining traction. Indeed, Cadel Evans, arguably Australia’s most celebrated cyclist, has tried to bring clarity to this divisive issue; stating that

I don’t think we should separate the two, because most people who ride a bike also have a car. In the end, they’re public roads for everyone. It’s a privilege to use roads; not a right.

 We have to respect everyone who’s using them, whether they’re driving a car, bus, tractor or truck, or riding a bike or are a pedestrian. We have to respect each other’s privilege and safety.”

in response to the question “What do you say to drivers who think cyclists don’t belong on the road?

Thirdly, the innovative solution of the peanutabout helps speak to ideas beyond the cyclist themselves – this is consistent with systems thinking which argues that safety (in this case, cyclist safety) emerges from a complex web of actions and interactions among a breadth of stakeholders who play a role in the larger safety system (e.g., in the case of my own research interests, an application of systems thinking in the young driver road safety). Given we are more than half way through the Decade of Action for Road Safety, and in the case of Australia, our road toll returned to an upward trajectory in 2016 after many years of a downward trajectory, such innovative thinking is critical.

Fourthly, the researchers noted that the templates used by police to record crash-pertinent information did not provide adequate details regarding the crash circumstances. Unfortunately this is not an uncommon problem, and again one that I have come across in my own research endeavours. If we are to effectively prevent injury, we need as much contextual and other information regarding the incident contributing to the injury.

Fifthly, while the peanutabout appears to be an ideal solution to the critical issues identified for the area noted, I am mindful that drivers do not always ‘cope well’ with complex infrastructure such as roundabouts. As a researcher within the realm of young driver road safety, and the mother of teen with the learner licence which requires full supervision whenever she is behind the wheel, Learner drivers often tell me that they ‘freak out’ when they come to a roundabout, and it is not actually round! According to Learners, roundabouts must be round, while oval roundabouts and others shaped as a parallelogram should be called something different. Hmmmm, on reflection, maybe Learners will be okay with a ‘peanutabout’…..

Finally, I paused to reflect on the safety implications for motorcyclists – another vulnerable road user group. While traversing a roundabout on his Harley Davidson last year, a colleague was driven over by a driver behind the wheel of 4WD, texting, who reported that she had checked the roundabout for vehicles before entering, and that she did not see – or hear – my colleague already on the roundabout (and thus he had right of way) until her front right tyre was on top of his leg and his motorbike. Thankfully he has managed to retain his leg, however he has had multiple operations, requires additional surgery, and will be scarred for life and never walk without support again. My colleague is the first to acknowledge that motorcyclists sometimes deliberately place themselves in danger through their riding behaviours – himself included – however we both eagerly await any intervention that will increase motorcycle safety when traversing complex infrastructure such as roundabouts.

Guest Blog: ‘Breaking Down Walls – Taking Translation and Dissemination to the Next Level’

26 Sep, 16 | by Angy El-Khatib

 

Often, when people think of translational research, it is through the lens of Grand Rounds, seminars, and conference presentations. It is usually clinical in nature and comes directly from the researcher. There is another type of translational research – NIH calls it Type 2 translation.

I am part of a Type 2 translational research team at a child injury research center. Our team of five has a mission to educate and empower the vast audience of people who care about kids and keeping them safe. We do this by sharing information on child injury in a format that is accessible by meeting health literacy guidelines and providing opportunities for prevention through realistic, actionable safety steps.

That’s a pretty lofty goal but we are very good at what we do. When researchers from our center publish papers, it is not unusual for their work to be picked up by media around the world. In the last six months, we’ve had two papers that had over one billion impressions (estimates of potential audience size), and two others that have had around one million impressions. It helps that our product is related to kids – it makes people care. But there is more to it than that.

In working with media, we strive to understand their needs and how to create value for them to cover our work. This is not as simple as it sounds. We spend several days working on a press release. Our hospital sees the value in the work we do and often contributes resources for us to create supporting videos, including sound bites, demonstrations, and B-roll.

We pay attention to the ever-changing way the masses consume information, staying up to date on the pulse of the public to meet them where they are. Gone are the early days of technology where you could create a website, direct people there, and then forget about it. Now, a website must stay fresh, providing new content frequently. It must also stay current in the way it looks. If its appearance is outdated, no one will look at your information because there will be the assumption (correct or not) that what is on the site is also likely outdated. People may believe you and/or your organization are outdated, or worse yet, irrelevant. We constantly assess social media platforms, analyze how we can best use them for maximum effect, and then develop our marketing plans.

We talk to doctors, administrators, researchers, and other public health professionals about the findings of our research. We also train them to effectively communicate with those who trust them and look to them for guidance. After that, we can’t sit back and rest on our laurels – we have to do it all over again, and then again. By doing all of this, we increase the likelihood of and the speed with which our research can lead to changes in policy, regulation, and behavior.

In the realm of translational research, teams like ours are not the norm and our team didn’t become this successful overnight. When our manager began her quest to have a team devoted to translational research, translation and dissemination were barely on the radar. Beyond journal publication, dissemination typically just meant printing  copies of a paper and having it available upon request or presenting it at conferences. Our manager had a vision of something bigger and better. She specializes in health communication and has the passion and drive to push for what she believes in. Her director supported her vision and was willing to take a chance on, and fund, something that really hadn’t been done.

Slowly, she grew her team. What makes us effective and successful is that although we each have our own projects to manage, we bring our complementary sets of skills and experiences to the table, both literally and figuratively, collaborating on all of our products. These products include press releases, multi-media releases, media interviews, blog articlescynthia-anderson-profile-picture, website development and management, social media outreach, toolkits, photo shoots, conference planning, and network building. We hone our work through brainstorming sessions, writes, edits, and re-writes. Our work is always better after it has been through the rounds of the team.

Our manager began winning over colleagues one researcher at a time, as they saw the reach and the impact of their work grow. It took 10 years for her to get her team to where we are now – having a big impact and doing innovative work that can help keep kids safer.

Written by:
Cynthia Anderson, MPH, CHES.
She is a Program Coordinator at The Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus, Ohio. She can be contacted at cynthia.anderson@nationwidechildrens.org.

 

 

Celebrating science and inspiring the next generation of scientists

22 Aug, 16 | by Bridie Scott-Parker

Last week in Australia was National Science Week, a nation-wide celebration of science and technology via three key pathways.

Pathway one is to inspire the general public to be involved in science – creating new knowledge – through engaging activities such as Citizen Science. This year’s Citizen Scientists are identifying Australian wildlife that are featured in photos captured via automatic cameras, and anyone with internet access can participate whether they have a university qualification or not. This fantastic activity means that science is indeed inclusive, when many times it can feel like science is a members-only club.

The second pathway is through showcasing the contributions of scientists to the world of knowledge through the Australian Institute of Policy and Science Tall Poppy Awards. As the joint-Queensland 2015 winner of this award, I was delighted to attend the 2016 award evening on Wednesday and was pleased to learn about innovative projects across a breadth of disciplines, such as infecting coeliacs with hookworms, the sexual attractiveness of facial hair, and optimising agricultural irrigation to name a few. Next month I will be one of the inaugural Flying Scientists, bringing science to rural regions in which exposure to science can be limited.

The third pathway relates to a flurry of activities to inspire the next generation to be scientists – both today and in their future education and career paths. Recognising the importance of encouraging girls in particular to become – and stay – engaged in scientific pursuits, I was delighted to host the first University of the Sunshine Coast Growing Tall Poppies program in my research unit here at the University of the Sunshine Coast earlier this year.

Adolescent Risk Research Unit team members Jeanne, Jamie, and Natalie, mentoring Sasha, Isabella, Mikayala, and Sian.

The four Grade 10 students learnt about career paths through and in science, and conducted their own research project under the guidance of members of my team, before making a presentation of their research activities and the key findings before the senior school assembly on Wednesday morning. This presentation was very well-received by the students and teachers in attendance, further breaking silos such as ‘academics’, ‘schools’, and ‘science’ which can pervade.

Bridie with the 4 GTPs after the school assembly presentation

Bridie and the 4 GTP stars after their school assembly presentation.

If we are to continue to effectively prevent injury, we need to make science accessible to everyone, and to the next generation especially.

 

On advocacy: championing young driver safety

2 May, 16 | by Sheree Bekker

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[SB] In this post, public health consultant Dr Sarah J Jones (follow her on Twitter @GDLSarahJones), an advocate for better safety for young drivers and all
who share the roads with them, shares her experiences on her efforts to advocate for Graduated Driver Licencing in the UK
. In her previous role, Sarah was an injury epidemiologist at Cardiff University, researching a range of injury prevention topics and completing a PhD on Child Pedestrian Injuries and Deprivation, a study that included analysis of the links between traffic calming distribution, deprivation and narrowing inequalities. 

[SJJ] It all began in 2008. I was in the final stages of Public Health Registrar Training when my supervisor told me to “go somewhere and do something”. My interests in road traffic crash prevention lead me first to Dot Begg at Otago, Dunedin and then on to Erin Cassell at Monash, Melbourne. The main objective, as well as a fascinating insight into how pandemic flu and other public health issues were being dealt with (I travelled the week after the 2009 swine flu pandemic first emerged), was an estimate of the effect that Graduated Driver Licensing (GDL) could have if implemented in the UK.

Back home, I presented what I had done, sat back, exceptionally pleased with myself, after all the case was now made, and awaited the “pat on the back” from my supervisor. “Nice” he said. “Now get it implemented”. “How” I lamely asked. “I don’t know. Work it out” was the response.

I’m still trying to work it out. Seven years on I have talked to a lot of people. I’ve given presentations to vaguely interested lay people in village halls, as well as to Members of Parliament. I have written articles for newspapers, magazines and peer reviewed journals. I have given newspaper, television and radio interviews, some live, and have participated in “phone-ins”.

Yet, we still do not have GDL in the UK. So, in seven years, I have achieved nothing.

I think people are more generally aware of GDL than when I started talking, but that may be completely unrelated to anything I have done. I am still looking for the guide on “How to bring about legislative change”, but there does not seem to be one. I have learned a lot about the policy process in the UK and about how reluctant people are to change their viewpoint, even in the face of overwhelming evidence to the contrary.

I always knew that the pace of Public Health change was painfully slow, but even with that knowledge continuing to advocate for change is difficult and often demoralising. It’s little wonder that we have become locked into a cycle of quick fixes (action that is just a proxy for effective action) to match political cycles that can then be quietly sidelined when they do not have the effect that was intended.

After 8 years in research / academia, my move into service based public health was my “translational research”. I am coming to believe that advocacy is the most important, but most overlooked area of both public health and injury prevention, partly because it is so difficult to measure the effect of what is being done. How we support people to become effective advocates is likely to be key to effective intervention prevention in the future.

[SB] I too have written on the vital importance of advocacy: here and here. As researchers, it is important to remember that we do not always need to disseminate purely our most up-to-date research results, or even the most innovative interventions; sometimes our work life’s work is bigger than that. Sometimes we need to advocate for the very heart that lies at our work: simple, credible information and resources that can make a difference in even one person’s life.

“The Beautiful Game”… minus headers?: Discussing USSF’s recent announcement to limit headers in youth soccer leagues

23 Nov, 15 | by Angy El-Khatib

In the United States, sports-related traumatic brain injuries (concussions and otherwise) have been a HOT topic. In 2013, approximately 4,500 former NFL players sued the league, claiming that the NFL failed to educate, manage, and protect its players from head injuries. Judges approved a settlement of $765 million that would fund concussion-related compensation, including medical exams and research for ex-players. This past year, Chris Borland, a 24 year-old, highly revered linebacker, decided to retire after playing only one year of professional football. His reasoning was that football was “not worth the risk” to his health.

The NFL is not the only sporting organization looking at concussions among its players; other organizations include the National Hockey League (NHL) and the National Collegiate Athletic Association (NCAA). Most recently, the U.S. Soccer Federation (USSF) announced that it has developed a set of guidelines for its youth leagues in which it recommends a ban on headers for players ages 10 and under and a limit on headers for players between 11 and 13 years of age. The USSF also developed a standard protocol in which medical professionals, as opposed to coaches or referees, make decisions about return-to-play for players who are suspected of sustaining a concussion.

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The USSF developed these guidelines in response to a class-action lawsuit which targeted six of the largest youth soccer groups, including FIFA, U.S. Youth Soccer, and the American Youth Soccer Organization. The lawsuit claims that these organizations have “failed to adopt effective policies to evaluate and manage concussions.”

But will policy changes – “banning headers” – solve the concussion problem among youth soccer players?

Unlikely.

A September 2015 study in JAMA by Comstock, et al. evaluated trends in soccer concussions among youth players. The study found that the most common concussion mechanism was contact with another player (player-player), not a ball – this is consistent with other literature.

The most common mechanism for all concussions was contact with another player, accounting for 68.8% of all concussions among boys and 51.3% among girls. The most common mechanism among heading-related concussions was also contact with another player, accounting for 78.1% of heading-related concussions among boys and 61.9% among girls.

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Among soccer-specific activities, heading was responsible for 30.6% of concussions among boys and 25.3% of concussions among girls.

The study concludes that reducing athlete-athlete contact across all phases of play – not just headers – would be more likely to prevent concussions. It also mentions that, culturally, banning headers may not be a feasible prevention effort. After all, an integral part of the Beautiful Game is headers (Robin Van Persie during the 2014 FIFA World Cup, anyone?). The soccer community, anecdotally, seems exceptionally resistant to the prospect of banning headers. As injury researchers, we know that one of the most important aspects of a successful and effective public health intervention is cultural feasibility.

With this in mind, I don’t think it is likely the USSF’s announcement about banning or limiting headers will significantly affect the epidemiology of concussions in youth soccer.  At most, this sends a strong message to coaches and brings safety management to the forefront. (The new rule which requires a Health Care Professional, [shoutout to Athletic Trainers!] to be present to make decisions regarding concussions instead of coaches or referees could be positive, though!)

Either way, one has to commend USSF’s attempt at targeted prevention efforts to bring soccer to its high and honorable state:

 

Joga Bonito!

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P.S. – you’re not allowed to make fun of me for calling it “soccer” instead of “football”! 🙂

Data viz: adolescent injury and mental health

10 Jul, 15 | by Klara Johansson

I’m addicted to interactive visualisations of data, when they are well-made, informative and easy to use. One that I’ve returned to repeatedly is the “GBD 2010 Heat Map“, which ranks causes of deaths and DALY’s globally. The graph is based on the Global Burden of Diseases, Injuries and Risk factors Study, an impressive project that aspires to quantify mortality and morbidity globally. (Needless to say, the uncertainty intervals are wider for countries lacking comprehensive mortality registration… but it is especially for those settings that this project is invaluable!)
It’s a quite simple graph, but the beauty lies in how easy it is to shift between the measures, groups and countries/regions you are interested in. NB: The picture below is just a static image showing only the age groups I selected for this blog post, go to the live graph to explore other options than those shown here.

One thing that stands out very clearly in this graph is something we are already aware of: that injury prevention is an urgent issue among adolescents and young adults. Of the top ten causes of death worldwide in the ages 15-19 and ages 20-24, injuries rank as first (road injuries), second (self-inflicted), third (violence), fifth/ninth (drowning) and ninth/tenth (burns).

If we would change* the measure shown to YLD – years lived with disability – the main cause of morbidity for those aged 15-24 is depression; other mental health problems such as anxiety, conduct disorder and substance abuse are also among the top ten (see the graphs for ages 15-19 and ages 20-24 ).
These two issues – injuries and mental health – are not unrelated. Of course, mental health problems are strongly related to suicide and self-harm. But a recent article in Injury Prevention by McDonald, Sommers & Fargo also highlights the complex interrelations between mental health problems and risky driving, a complexity that seems particularly prominent among adolescents and young adults compared to adults. The article is based on a sample of youth and adults who are high-risk drivers, and shows, for the younger group, several significant pathways from depression and conduct behavior to various aspect of risky driving. (Similar results have been demonstrated earlier for example by our own Bridie Scott-Parker, a short report here in Injury prevention, and a path analysis in British Journal of Psychology.)
Thus, to some extent, mental health promotion and injury prevention need to go hand in hand, maybe especially among adolescents.

 

* In the live graph, select the measure you want by using controls in the top panel. Here you can also select age groups, male/female/total and countries/regions. Selecting regions can be a bit tricky, which I find to be the main drawback of this graph.

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