Barriers and Enablers to Enacting Child Injury Prevention Legislation related to Road Users in Canada CARSP Conference 2016, Halifax NS A. Macpherson, York University, Toronto L. Rothman, York University, Toronto P. Fuselli, Parachute, Toronto K. Belton, Injury Prevention Center, Edmonton L. Olsen, University of British Columbia, Okanagan I. Pike, University of British Columbia, Vancouver Slide

INTRODUCTION Injury prevention policy Effective however, legislation is not uniformly adopted Decisions regarding enactment may vary Previous research has looked at general public policy or health policy1,2 Factors related to enactment of injury prevention legislation may be different than other child health legislation and public policy For example, A Cochrane review of bicycle helmet laws, for example, reported that helmet use has increased, and head injuries have decreased in every study -Effectiveness of Graduate Driver’s licensing reported a reduction in motor vehicle collisions among young drivers subsequent to the introduction of this policy 1Innvaer S, et al. , Health Serv Res Policy 2002 2Oliver, K, et al.." BMC Health Services Research 2014

OBJECTIVE To identify key barriers and enablers to enacting child/youth injury prevention legislation related to road users in Canada

METHODS Purposive snowballing sampling Individuals involved in injury prevention policy Online survey Identify relevant policies and whether legislation existed in their province “Which injury topics are relevant to you? Please indicate whether NO policy/legislation in your province or “YES” policy/legislation in your province”

METHODS Importance of barriers or enablers 5-point Likert scale Frequency (%) agreement (somewhat + strongly agree) By length of time since enactment Open-ended comments By theme Identified as a barrier or enabler “Legislation for _________ has not been instituted in my province because:” “Legislation for ____ as it currently stands has been instituted in my province because:” OR

RESULTS Top 4 Topics and Existing Provincial Legislation 57 respondents with representation from all 10 provinces

Provincial Legislation Implementation Dates (as of January 2015)   Bicycle Helmets Cell Phone, Distracted Driving Booster Seats Graduated Driver’s License British Columbia All ages, 1996 2010 2008 1998 Alberta < 18, 2002 2011 X 2003 Saskatchewan 2014 2005 Manitoba < 18, 2013 2012 Ontario < 18, 1995 2009 1994 Quebec 2002 1997 New Brunswick All ages, 1995 1996 Nova Scotia All ages, 1997 2007 Prince Edward Island All ages, 2003 2000 Newfoundland 1999 89 schools no collisions X – No legislation

RESULTS Legislation is important >80%: benefits outweigh the costs 87%: because of costs for those injured >89%: because of the number of injuries for each topic >80%: benefits outweigh the costs Personal experience 92% GDL 64% cell phones, distracted driving 53% bicycle helmets 37% with booster seats

RESULTS (n = 14) Barriers to Bicycle Helmet Legislation Not enough managerial or political support (n = 8) Competing policy priorities (n = 8) Very few barrier responses as most provinces had legislation except for bike helmets. Most frequent = competing policy priorities, not enough managerial or political support

ENABLERS: Legislation as it currently stands has been instituted in my province because… All Top 4 Topics

ENABLERS: Legislation as it currently stands has been instituted in my province because… Individual Topics Great degree of variability with respect to enablers of legislation by topic (Figure 2b) -For example, research was identified by a high proportion of respondents as an enabler especially for GDL and booster seats, but was not as important bicycle helmets. Media attention was identified as an enabler by a high proportion of respondents for cellphone, but not as much for the other topics. Legislation enacted in other provinces was especially important for cell phone,and booster seats, but not as much for bicycle helmets and GDL.

RESULTS Other common research enablers Research of sufficient quality/quantity that was easy to understand, Research in a useful format and affiliation of researchers with reputable organizations Less important Researchers had similar priorities as policy makers Researchers understood the policy process

RESULTS Important >80% for newer legislation (within 7 years) Time since enactment unrelated to enablers Exceptions: Media attention and policy already enacted elsewhere Important >80% for newer legislation (within 7 years) Booster seats (Saskatchewan, Manitoba) Bicycle helmets (Manitoba) Cell phone, distracted driving legislation (All provinces) ; heterogeneity in enablers by topic even with similar lengths of time the legislation had been in place

ADDITIONAL THEMES (Open Ended) Population burden and severity of injury Evidence of preventability, risk reduction Availability of surveillance data United opinion re: topic Legislation already exists in other jurisdictions Timing Adequate enforcement Costs of equipment Low burden = barrier (e.g. ski helmets) High burden, high severity = enabler (e.g. GDL, cell phones) Preventability – e.g helmets, however, still not sure how much cell phone use = collision- evidence just emerging Surveillance data –and cell- phone - barrier United opinion = lack of - bike helmets. More so re: policy related to children and youth (e.g. booster seats, GDL)

DISCUSSION First study to describe barriers and enablers of policy specific to child and youth injury prevention topics in Canada #1 Enabler: Research Effectiveness, surveillance Collaboration between researchers and policy makers Additional themes: United voice, costs, enforcement -surveillance in terms of the injury as well as the use of the device. -Results indicated there were different enablers and barriers depending on the topic. -This study emphasizes that important information may be lost if topics are considered together, and that the attention to the uniqueness of issues surrounding particular injury topics may be instrumental in policy development.

Important to consider injury topics separately as uniqueness of issues around specific topics may be instrumental in policy development Common injury priorities must be developed early on in the research process also that common injury prevention priorities must be developed between policy makers and researchers to ensure research is used effectively in the legislative process. Findings can help inform the process of turning injury prevention evidence into policy action.

ACKNOWLEDGEMENTS Funding CIHR Strategic Teams in Applied Injury Research (STAIR) CIHR Chair in Child and Youth Health Services and Policy Research (Dr. Alison Macpherson)