Injury Insights: Research (April 2025)
Here is the second installment of our Injury Insights: Research series. A selection of publications by BCIRPU researchers will be highlighted in this series.
Retheorising ‘Risky’ Play in a Global Context: Addressing the Safety Needs of Refugee and Displaced Families (February 2025)
Authors: Michelle E. E. Bauer, Samar Al-Hajj, Elise Presser, Amin Zahwe, Sary Faraj, Ian Pike
For Syrian refugee children in Lebanon, play is often as dangerous as it is essential. A recent study involving 79 children and 56 caregivers highlights how overcrowded and hazardous environments in refugee camps can lead to frequent injuries. Key findings revealed two themes: (1) that families living in these environments preferred the term “dangerous” rather than “risky,” as unsafe conditions, such as proximity to construction or cooking equipment, put children at risk for injury and impacted play; and (2) environmental and social barriers—like gender norms, financial constraints, and discrimination—limit opportunities for safe play.
This project critiques Euro-Western perspectives that dominate risky play scholarship. By centering refugee voices, the research highlights that “risky play” should be redefined within a global context to consider the unique challenges faced by displaced families. Researchers emphasize the need to consider injury inequities in marginalized communities. The study calls for culturally relevant safety materials and systemic changes to improve access to safe play spaces and health care.
Read more in the journal Sociology of Health & Illness.
Review on Residential Fires (November 2024)
Authors: Hasana Bilal, Colleen Pawliuk, Ian Pike
This rapid review synthesized evidence from multiple studies to evaluate interventions and risk factors for reducing residential fires in vulnerable communities, guided by the Sendai Framework for Disaster Risk Reduction. The review identified key risk factors, including vulnerable populations (children, seniors with comorbidities), behavioural issues (smoking, alcohol use), and environmental characteristics (lack of fire safety technologies, inadequate housing). Effective interventions included smoke alarms, residential sprinklers, and community-based fire safety programs, which demonstrated measurable impacts on fire incidence, mortality, and morbidity when supported by robust statistical analyses and control groups. However, significant gaps in evidence were noted, particularly regarding Indigenous communities, limiting the generalizability of findings to these populations.
Findings align with the Sendai Framework’s priorities, offering recommendations to enhance governance around disaster risk, invest in resilience-building measures, and improve preparedness to improve emergency responses.
Read more in the report by the British Columbia Injury Research and Prevention Unit (BCIRPU) for Statistics Canada.
Cross-country policy comparison of 30 km/h speed limits (January 2025)
Authors: Lauren Pearson, Megan Oakey, Breanna Nelson, Mojgan Karbakhsh, Shazya Karmali, Ben Beck
This comparison study asked experts about the barriers and enablers of implementation of 30 km/h speed limit zones in the state of Victoria, Australia, compared to British Columbia, where implementation has been more successful. The study revealed different barriers and enablers between the two regions.
In B.C., where municipalities have autonomy to implement 30 km/h speed zones, successful implementation was more readily realized due to a legislation clarification from Ministry of Transportation and Transit in 2022, community interest, particularly in affluent areas, and by building on the efforts for slower speed and increased safety around schools. Conversely, Victoria's restrictive trial-based policy created delays and resource burdens for local councils, which limited widespread adoption despite strong support for change. The lack of locally applicable evidence on optimal placement of these lower-speed zones also had a negative effect on adoption. Experts also emphasized that speed limit reductions must be paired with traffic calming measures to create "self-explaining" roads that signal slower driving speeds to drivers by design.
Read more in the journal Cities & Health.
Built environment change for injury prevention: Insights from public health professionals across public health units in Ontario, Canada (January 2025)
Authors: Emily McCullogh, Alison Macpherson, Daniel W. Harrington, Ian Pike, Brent Hagel, Claire Buchan, Pamela Fuselli, Sarah A. Richmond
This study explored the experiences of public health professionals in Ontario, Canada, regarding built environment (BE) changes aimed at reducing road-related injuries and deaths. Qualitative data from key informant interviews and virtual focus groups with participants from four Public Health Units were analyzed, using thematic analysis aligned with the Ontario Public Health Standards (OPHS).
Researchers found significant barriers to enhancing safety for vulnerable road users, including a motor vehicle-centric culture prioritizing traffic flow and complex decision-making processes at the municipal level. Facilitators such as partnerships, champions, and access to reliable data were identified as critical for advancing BE changes. This study highlights the role of public health professionals in leveraging evidence and fostering collaboration to encourage injury prevention initiatives. Authors emphasize the need for increased resources, funding, and cross-sectoral engagement to address systemic barriers and support effective programming.
Read more in the journal BMC Public Health.
Children's Risky Play and Resilience: Perspectives of Emergency Care Practitioners: (February 2025)
Authors: Michelle E. E. Bauer, Laura Cunningham, Meghan Gilley, Ian Pike
This study explored the perspectives of emergency care practitioners (ECPs), who are also parents, on children’s risky play and its role in fostering resilience, addressing a critical gap in understanding how medical expertise and parental instincts intersect in perceptions of risk and child development. The research revealed that ECP parents view risky play as essential for building resilience, particularly through learning to persevere through failure, developing distress tolerance, and fostering autonomy. While these parents acknowledged the potential for minor injuries, they differentiated between "risky" play, which offers developmental benefits, and "dangerous" play, which poses severe risks. Their unique dual roles as both medical professionals and caregivers allowed them to balance an awareness of injury prevention with an appreciation for the long-term emotional and social benefits of risky play.
However, the study highlighted concerns about societal overprotection and the normalization of safety anxieties, which may hinder children’s opportunities to develop independence and self-confidence. The findings underscore the importance of reframing public health messaging to emphasize the developmental value of risky play while encouraging familial discussions that include children’s voices in decisions about safety. The study calls for further exploration of how diverse experiences with injury influence parental attitudes, suggesting that integrating these insights could help address the growing challenge of risk deficiency among children in Euro-Western societies.
Learn more in Child: Care, Health and Development.
- distress when a child was in pain and when a family was grieving; and
- sadness in the event they were not able to save a child in their care.
- concern for the injured child and the child’s family;
Particularly traumatic events, such as those involving vivid sights and sounds (e.g., families holding each other and having extreme reactions), stuck with the practitioners, having long-lasting impressions on them and causing them to re-live these events in the years following their exposure.
Even after their shift was over, practitioners said that they changed how they approached parenting and how they perceived safety during play as a result of witnessing these traumatic events. They reported having more knowledge of the causes and consequences of severe injuries, such as those that require hospitalization or emergency care. For example, practitioners were more likely to enforce boundaries around where their children could play, such as by forbidding their child to play near busy streets. They also were more likely to tell their child about safe play environments and equipment, and put this equipment on their child before play, such as explaining the benefits of using helmets while riding bikes.
Practitioners were more likely to enforce boundaries around where their children could play, and use safety equipment, such as bike helmets.
Practitioners also described being concerned about their children’s play near open windows, around large bodies of water unsupervised, and in environments where firearms were present. They also expressed worry about their children’s play on trampolines and on motorized vehicles, such as ATVs. Findings related to trampoline play safety concerns were published in the journal Injury Prevention.
Observing family grief due to child injury or death affected the mental well-being of health care practitioners, drawing attention to the need for mental health supports for those involved in caring for severely injured and dying patients.
"Raise more resilient children through play...watch and see how your child handles challenging tasks without intervening right away." —Dr. Michelle Bauer
Building resilience through play
How can parents help their children build resilience? By letting them play!
The experiences that practitioners witnessed encouraged them to support their children in building resilience through play; specifically, by supporting children in learning to cope with failure, overcome fear, build self-confidence, develop distress tolerance, and regulate negative emotions. Findings related to building resilience through play were published in the journal Child: Care, Health, and Development.
Parents fostered resilience in their kids by:
- helping their kids get back on bikes after they fell off and wanted to try again;
- sitting on their hands so they did not instinctively reach for their children when their children fell down; and
- encouraging participation in challenging and thrilling activities in forests and water while safety equipment was used.
"There are a few ways that parents can raise more resilient children through play that are supported by literature and our study findings," said Dr. Bauer. "One: watch and see how your child handles challenging tasks without intervening right away."
"Two: Ask your child how they want you to help—let them tell you what makes them feel safe and happy during play. Let them lead. And three: make play both safe and exciting by encouraging risk-taking, teaching them how to avoid hazards, and using safety equipment.”
This research was supported through Drs. Bauer’s and Gilley’s receipt of a clinical and translational research seed grant from the BC Children’s Hospital Research Institute (BCCHR), Dr. Bauer’s BCCHR postdoctoral fellowship award, and additional training provided to Dr. Bauer through her participation in the Programs and Institutions Looking to Launch Academic Researchers (PILLAR) program through ENRICH, a national organization training perinatal and child health researchers.
Learn more about the study through two infographic posters:
Graphics and posters by Milica Radosavljevic
