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Table 2 Final list of recommendations

From: Youth injury prevention in Canada: use of the Delphi method to develop recommendations

Recommendation

Rationale

1. That federal, provincial, territorial and municipal governments, health and funding agencies make meaningful investments to support organizations that lead injury prevention initiatives in Canada.

Organizations that lead injury prevention efforts must be supported. In order to prevent injuries and enhance the lives of youth, it is necessary to change public attitudes around the acceptable frequency of injury events; the risk factors and causes of injury; the types and severities of injuries; the life-long impact that injuries can have; the time lost from education and other healthy activities; the pressure that injuries add to the health care system; the economic burden to society and families; and the fact that the vast majority of injuries are preventable.

2. That federal, provincial, territorial and municipal governments, health and funding agencies make meaningful investments to establish and continue comprehensive injury surveillance, inform injury prevention initiatives, monitor and evaluate outcomes and identify new and emerging patterns of youth injury.

Like chronic and infectious disease surveillance, it is critical that injury trends and patterns, which include social and contextual determinants, are monitored and evaluated over time. Efforts to collaborate and share injury data and information will increase understanding and the ability to take strategic actions to reduce and prevent injuries.

3. That federal, provincial, territorial and municipal governments review, establish and enforce regulatory and evidence-informed policy solutions to prevent and control injuries.

The role of government in injury prevention through the development and enforcement of good policy is essential. Examples include, but are not limited to, policies that promote training and safe operation of motor vehicles and off-road vehicles, reduction of impaired driving both on roads and in off-road situations, helmet use during wheeled activities, skiing, and snowboarding, and concussion prevention and management.

4. That federal, provincial, territorial and municipal governments, health and funding agencies implement policies and programs to minimize use of alcohol and drugs by youth. This includes efforts to address the culture that promotes alcohol and drug use, controlled regulation of alcohol sales, education on youth substance abuse and high-risk behaviours, and establishment of programs and services to address addictions.

Services, regulations and programs that address the use and abuse of alcohol, prescription and illicit drugs are critical. Substance use can lead to increased risk-taking and impairments that leave young people vulnerable to major injury. The recreational use of drugs and alcohol among passengers and drivers of off-road vehicles is a concern particularly in rural settings. Alcohol and drug use is also a marker for other lifestyle behaviours that lead to higher risk of injury.

5. That public health personnel, police liaison officers, Parent Advisory Councils, school districts, municipalities and other community and neighbourhood youth serving agencies continue to support and advocate for programs and policies aimed at preventing youth drug and alcohol abuse and promoting associated harm reduction programs as a protection against injury.

Injuries were more common among youth who reported illicit or prescription drug use, binge drinking or whose friends abused drugs or alcohol. Public health personnel, police liaison officers, Parent Advisory Councils, school districts, municipalities and youth servicing agencies can assist governments and funding agencies by advocating for, leading or supporting initiatives to address substance use.

6. That federal, provincial, territorial and municipal governments, health and funding agencies support policies, programs and services that increase food security and reduce family dysfunction.

This report has noted the relationship between injuries and youth of low socio-economic status or who go to school or to bed hungry. Among boys in grades 9–10, for example, those who reported often going to school or bed hungry were four times more likely to also report one or more home injuries. Efforts to reduce injury must be multifaceted and include research (see Recommendation 17 below), food security and other family support programs.

7. That injury researchers collaborate with medical and social welfare professionals to better understand injury risks and social disparity risk factors leading to home injuries, particularly among youth in foster care, and develop concrete recommendations for injury prevention initiatives based on this understanding.

Approximately 12 % of all youth injuries occur within the home and yard setting and not all youth are at equal risk of sustaining a home-based injury (see recommendation 6). A greater proportion of younger girls and older boys residing in group homes or foster care, for example, reported more injuries and severe injuries than their peers who were not in foster care. Injury prevention efforts need to be informed by greater understanding of the factors leading to these home injuries.

8. That Provincial and Territorial Education Ministries further integrate injury prevention education (e.g. bullying prevention, suicide prevention, drowning, burns, motor vehicle, sports injuries) into the school curriculum for grades 6 to 10 (and ideally from Kindergarten) and institute school policies to protect students from school-related injuries.

Because children and youth spend much of their time at school, examining the relationship between characteristics of the school setting and injury risk is extremely important. The school setting is an ideal place to integrate and evaluate injury prevention efforts, since children and youth can become involved in injury prevention initiatives at school, and many activities that can lead to injuries (e.g. playground use participation in school sports) occur in this setting.

9. That public health personnel, police liaison officers, Parent Advisory Councils, municipalities and other community and neighbourhood agencies review and understand the scope of youth injury in their community in order to implement and evaluate evidence-based injury prevention policies, programs and initiatives.

Every community has groups who are at higher risk for injury, such as youth from lower socio-economic status families or boys from affluent families who engage in high-risk sporting activities. The local injury stakeholders listed above need to work together with the researcher community to target and evaluate injury prevention initiatives towards high-risk groups.

10. That the Canadian Collaborating Centres for Injury Prevention and Parachute Canada partner and collaborate with Active Healthy Kids Canada, ParticipACTION, neighbourhood youth serving agencies and coaches to integrate injury prevention into the promotion of healthy physical activity for children and youth.

Physical activity and play are essential to healthy development among children and youth, but may be accompanied by increased risk of injury. Collaborations between those promoting physical activity and play, and injury prevention partners are essential to ensure safe, yet stimulating environments for healthy development. Examples include: redesigning school and community playing fields, play spaces and active transportation routes; informing school policies regarding bullying and supervision; providing return-to-play guidelines; providing sport-specific injury prevention; and integrating bullying interventions into physical activity promotion.

11. That municipalities, community and neighbourhood leaders, Parks and Recreation and schools work with youth to create safe physical environments where youth want to spend time.

Development of spaces for physical activity and play can positively influence sense of community and foster trust in neighbourhood, which is important for injury reduction. In addition, the provision of environments promoting physical activity can have positive influences on other health outcomes such as obesity.

12. That school districts, school administrators and Parent Advisory Councils review, continue to implement and support anti-bullying and anti-violence policies and programs that target perpetrators, victims and bystanders.

This report found that children and youth who reported being bullied were up to twice as likely to be injured than those who did not report being bullied. This association was particularly strong for boys in grades 6–8 and girls in grades 9–10. School administrators must lead in the delivery of appropriate consequences for bullying behaviours.

13. That school districts, school administrators, Parent Advisory Councils and youth leadership groups implement peer-mentorship programs that address the social context of the school environment and improve feelings of belonging and safety.

This report found a relationship between injury and emotional well-being, such as not feeling respected or not belonging at school. Schools must work together with local youth serving agencies, Parent Advisory Councils and youth to create a culture that fosters inclusiveness, respect and improves tolerance of differences/diversity and discourages bullying.

14. That research funding bodies support programs of research that seek to understand the fundamental determinants of youth injury, including surveillance to identify new patterns and trends, and interventions that target specific high risk and/or vulnerable populations, contextual determinants and risk and protective factors.

While this report provides some insights into the relationship between social and contextual determinants, risk and protective factors, and youth injury, more research is needed to enhance our understanding. Recommendations 15 to 19 are directed at the injury research community, including academic and applied researchers, policy makers and practitioners to develop innovative research projects that shed light on the following specific areas in relation to injury: substance use, high-risk youth, going to bed hungry, peer relationships and involvement in a sport club, youth club or voluntary service.

15. That research programs are developed and supported to improve understanding of the culture that promotes the use of alcohol, illicit and prescription drugs for recreational purposes, and the impact on child and youth injury patterns and rates.

As stated in recommendations 4 and 5, alcohol, illicit drug and prescription drug use are increasingly important risk factors for adolescent injury. Further research will aid our understanding of where and how to intervene.

16. That research programs are developed and supported to implement optimal methods to prevent injury among high-risk and/or vulnerable youth, including those from rural and remote regions; investigate recurrent determinants and patterns of injury; social disparities; and, risk and protective factors.

The risk of injury is not the same for all children and youth as some characteristics and behaviours increase or decrease risks for injury. In addition to level of family function, being bullied, involvement in high-risk sports, and use of alcohol, illicit and prescription drugs, this report found that the proportion of students reporting an injury increased as the population size of the city or town where they attended school decreased. Further research and evaluation is needed to inform targeted interventions for all high-risk children and youth, including those living in rural locations (<1,000 population).

17. That research programs are developed and supported to investigate the relationships between going to school or bed hungry and the increased risk for injury among youth, with a particular focus on policy solutions.

Understanding of the relationships between food insecurity, family dysfunction and injury among youth will allow solutions to focus on some of these root causes.

18. That research programs are developed and supported to illuminate understanding of the effects of various child and youth peer relationships and peer activities on injury risk.

The current findings suggest that there is merit in exploring social and contextual factors when creating injury prevention programming. Among girls, having close male friends increases the risk for injury; however, having close male friends is a protective against the occurrence of injury among older boys. As risk factors for injury vary for boys and girls, further research and evaluation is needed to inform targeted interventions.

19. That research programs are developed and supported to understand child and youth involvement in sports and social clubs as a protective factor against injury.

Children and youth involved in voluntary service, youth clubs, and other clubs were 10 %, 12 %, and 14 %, respectively, less likely to report injury than those not involved in these clubs. Research is needed to discern whether involvement is protective at the individual, interpersonal, and/or organizational level.