1. 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

2. 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

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

4. 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”

5. 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

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

7. 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

8. 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

9. 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

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

11. 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.

12. 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

13. 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

14. 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)

15. 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.

16. 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.

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