Mariana Brussoni

In this dissertation I explore the complexity of efforts to make the City of New Westminster more child-friendly and the creative capacities associated with these efforts. Over a period of two years, I carried out a participatory study related with the newly adopted New Westminster Child and Youth Friendly Community (CYFC) Strategy. The study involved a collaboration between 51 children, myself, adult community members, and other (human and nonhuman) bodies in a project focused on outdoor neighbourhood play. As part of this, I also interviewed 21 people who were involved in developing and implementing the CYFC strategy. In the process of this inquiry, I increasingly took up posthumanist thinking, experimenting with various ways of engaging the questions: How does the New Westminster Child and Youth Friendly Community Strategy work with other related bodies toward change? How might it? I operated with the idea that approaching these questions through posthumanism was not only worthwhile but vital for grappling with the complexities of urban child-friendliness and imperatives to ‘make a difference’ for children in this context. Thus, this research had hybrid qualities, moving from a traditional qualitative orientation toward a more post-qualitative approach. With the idea that child-friendliness is material, discursive, embodied, and situated, this inquiry connected with topics of: outdoor play; children’s travels to and from school; child/youth engagement; urban soundscapes; weather; loitering; multi-species relations; colonial entanglements; ontological politics; and the city as a site of learning. In exploring various realities associated with the CYFC strategy, I considered how the potential for New Westminster to become more child-friendly was entangled with a complex array of more-than-human relations.

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This dissertation explores whether Lakatos’ methodology of scientific research programs and Elster’s notion of causal explanations can be used to drive innovation in injury prevention research. For illustration purposes, the problem of low rates of booster seat use is applied to a case study. Contrary to popular belief, the purpose seat belts is not solely to prevent people from being ejected out of the car, but to redirect crash forces to stronger parts of the body: hips and chest. Children between the ages of 4 and 8 years are usually too small to wear the seat belt across the hips and chest, and may end up with the straps on their bellies and neck. If a child wears it in this way, the seat belt directs crash forces to the child’s internal organs or spine, potentially causing fatal injuries. For this reason, children of these ages require a booster seat; a device that raises the child and ensures the seat belt is placed correctly across the hips and chest. Unfortunately, in Canada, 50% of children aged 4 to 8 years ride in cars strapped in seat belts, but without booster seats. To address this problem, I formulate a hypothesis that explains why booster seat use is infrequent: parents are prone to see injuries to vehicle occupants as resulting from ejection. This fixation on ejection makes them more concerned about the child being thrown through the windshield, and less worried about the dangers of early use of seat belts. I term this proposition the ejection stereotype hypothesis. This dissertation spans over philosophy of science, psychology, decision science, visual arts, and injury prevention. After summarizing different views of scientific progress and discussing the philosophy of booster seat research, fuzzy-trace theory and the ejection stereotype are described. Next, a psychological study that reports a falsification test of the ejection stereotype is reported. Following, a visual arts project is described in terms of how Tufte’s principles of information design were used to develop an infographic to correct the ejection stereotype. Finally, a proof-of-concept pilot study to test the efficacy of the infographic is reported.

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In Canada, unintentional injuries are a leading cause of hospitalization for children aged 5-19 years old. The need for longitudinal studies examining the impact of non-fatal childhood injuries across age groups and injury types has been identified internationally. Health related quality of life (HRQoL) measures assess functional limitations in multiple health domains making HRQoL an interesting and appropriate outcome to measure the impact of injury. The overarching goal of this dissertation was to advance the understanding of HRQoL among children following injury and the appropriate analysis of longitudinal HRQoL data. A systematic review was performed to summarize the findings of research on HRQoL following pediatric injury, and to examine the methods used to measure and analyze HRQoL data in the childhood injury context. In addition, primary research was conducted with 365 children 0-16 years old and their parents who presented with an injury at a tertiary care pediatric hospital in Vancouver, British Columbia. Children aged between 5-16 years old and all parents completed questionnaire measures at the time of presentation for the injury and again at one-, four- and 12-months post-injury. How childhood injury and the process of recovery impacts children’s HRQoL from both the child’s and parent’s perspective was investigated. Four different longitudinal models were explored to determine the model that best fit the data.Analyses revealed that injuries among older children, children requiring hospitalization and children with lower extremity fractures had more significant impact on HRQoL at one-month post-injury. By four-months post-injury differences in HRQoL were minimal. On average, parents rated their children’s HRQoL lower at one-month post-injury relative to the children’s self-perceived HRQoL. Most injured children regained HRQoL baseline status by four-months post-injury. Non-linear quantile regression provided the best fitting model as it is robust to skewness and outliers and free from any assumptions regarding the distribution of errors. Older children, those hospitalized, and children with lower extremity fractures were at higher risk of having lower HRQoL in the early part of recovery relative to younger children, those seen in the ED and children with other types of injuries.

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Traumatic knee injuries are among the most common sport-related injuries sustained by youth and are associated with significant personal and societal burden, including increased risk of post-traumatic osteoarthritis (PTOA). Despite the key role of physical activity (PA) in prevention of disease, disability, and death, there is a paucity of knowledge surrounding PA participation, and other health-related outcomes for these individuals. The overarching aim of this dissertation was to understand the attitudes and beliefs, health-related outcomes, and PA participation of youth and young adults after recovery from acute knee injury, yet before onset of symptomatic joint disease. This dissertation is comprised of four studies. First, qualitative interviews were conducted with youth and young adults 3-10 years following intra-articular knee injury examining the influence of their injury on attitudes and beliefs about PA and PTOA. Four main themes were: acceptance of the injury impact; high determination and resiliency; lack of knee confidence; and evolving sense of athletic identity.Second, knee confidence was quantitatively examined in youth and young adults 3-10 years after intra-articular knee injury and age-and sport-matched uninjured controls. Individuals with a previous knee injury had over seven times greater odds of being troubled by knee confidence than controls. Third, the Swedish Knee Self-Efficacy scale (K-SES) was translated and cross-culturally adapted into English for individuals with an intra-articular knee injury in the previous five years. Measurement properties were evaluated and revealed high internal consistency, acceptable validity, and very good reliability. Fourth, objectively measured PA and other health-related outcomes were examined in female youth and young adults, 1-2 years after anterior cruciate ligament reconstruction (ACLR), as well as in age-and-sport-matched uninjured female controls. Participants with previous ACLR had less vigorous PA; increased knee pain and symptoms; reduced function in sports; lower quality of life; as well as poorer neuromuscular control than controls. Taken together, these studies highlight specific longer-term physical and psychological health-related outcomes that should be addressed in youth and young adults with previous knee injury. They support that these individuals deserve intervention beyond the traditional injury recovery period with the ultimate goal of preventing PTOA.

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