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CARSP SNN Video Interview Transcript (Spring 2024)

Date: April 11, 2024

Interviewer: Dr. Emily McCullogh, York University, member of CARSP editorial board

Interviewee: Dr. Linda Rothman, Associate Professor in the School of occupational and public health at Toronto Metropolitan University, prominent injury prevention and road safety public health researcher and advocate for Active and Safe Travel and the City of Toronto.

Emily: Can you tell us a fun fact about yourself? 

Linda: I love this question. I started university many years ago thinking I was going to be a classical guitarist, so I took music in my first year and some of the basic arts. My math teacher in high school would be shocked if he knew what I was doing right now because he used to let me bring my guitar to class and play because he knew I hated math and had no interest in it. If he knew I was doing biostatistics on a daily basis now, he would be surprised. So, I say to my students, keep your eyes and ears and hearts open because you never know where you might end up career-wise. Just take any opportunity that you have and follow your instincts.

Emily: How did you get involved in injury prevention and road safety?

Linda: After my initial music career I went on to do occupational therapy because I had planned to do music therapy, ultimately. I ended up working with children with neurological impairments in a rehab center and this included traumatic injury. I was working with people with disabilities as a result of catastrophic injuries. After six years of being a clinician I decided to do a master's degree, and in those days there was no degree in rehab sciences. I ended up in a program called Masters of Health Science and Community Health and Epidemiology at the University of Toronto. I think that was one of the precursors to the Masters Public Health program they have there right now. It was a great experience. 

After I graduated I decided I wanted to continue working with pediatrics but in prevention, rather than as a clinician dealing with the results of injuries. I was really fortunate to get a position with Dr. Andrew Howard who is an orthopedic surgeon, senior scientist, and injury prevention researcher at the Hospital for Sick Children. The first project I was hired to do was looking at kids who came in to hospitals as a result of car crashes and looking at what happened to them in the car. We worked closely with a collision reconstruction team of engineers out of Toronto Metropolitan University (TMU) to reconstruct crashes and see how the car seats failed for these kids. That research resulted in the design for a new booster seat for the older kids. This really started my career in injury prevention. After that, I worked with Dr. Howard on playground safety and body checking in hockey. We also looked at different types of car crashes and collisions. Eventually we moved to looking at vulnerable road users (pedestrians, cyclists, and kids) because we realized we are keeping kids safe in cars but it’s the kids who are out of the cars that are having more catastrophic injuries resulting in hospital admissions and surgeries. So, my career has moved more and more towards road safety. 

I eventually did a very late Ph.D. looking at the built environment and linking the concepts of active transportation and injury together because, at the beginning, people were just trying to increase active transportation without thinking about the injury implications, specifically in children. This work has expanded and it is the continued focus of my research looking at all ages. I am also more focused on the healthy cities approach and the role of public health in road safety.

Emily: What was your involvement in the adoption and implementation of Vision Zero as a road safety strategy in the City of Toronto?

Linda: It started with a Metrolinx Safe Schools committee. I met some of the people from transportation in the City of Toronto and in 2017 they asked me to join their School Safety Zone Committee. This is right at the beginning of the implementation of Vision Zero in the City of Toronto. We worked together on developing a prioritization list of schools for interventions. The prioritization list was based on KSI (killed and seriously injured) collisions with kids and other people, as well as the percent of that population that were able to walk within 1.6 kilometers of a school. The interventions were things like speed symbols, flashing beacons, pedestrian crossovers, watch your speed boards, and we evaluated 34 schools with some match controls. We didn't find huge differences before and after the interventions, but there was a little bit of a reduction of drivers going over the speed limit and there was a slight increase in active transportation. The takeaway from that project was that we need to be more bold with some of our interventions - it can't just be “lines and signs.” The interventions need to be actual changes to the roadway to slow traffic down. There were still a large number of cars driving past schools above the speed limit, which is something we really need to address.

We also did a school survey with parents across three of the schools and we found huge differences in the percentage of kids who were traveling to school by active transportation from 25%-98%. We wanted to know why this was happening. As things progressed with Vision Zero, I've maintained my relationships with the City of Toronto. Most recently, we have been involved with an automated speed enforcement evaluation with Dr. Howard and the team at SickKids and TMU. The automated speed enforcement has gone in around schools and community safety zones and we found them effective in slowing speed down. There has been a lot of interest from other municipalities on how we did the study and the methodology because we did find great success with automated speed enforcement. 

Based on other small study we did years ago with the CHASE (Child Active-transportation Safety and the Environment) grant, there are strong associations, particularly in the city of Toronto, between speeding and the numbers of kids walking to school. We want to make things safe but we also want to make things perceived to be safe so parents feel comfortable letting their kids walk to school. 

The other Vision Zero project that I have been involved in more recently is the evaluation of the cycle tracks that went in through Active T.O. during COVID-19. The City asked us for some input in an evaluation to support their argument at the municipal level to make them permanent in 2021. That was passed through City council and those lanes were made permanent. We are continuing that study right now with Calgary and Vancouver to evaluate some of the cycling infrastructure in terms of collisions over time.

Emily: So, those projects in the other cities are ongoing?

Linda: They are ongoing in Vancouver and Calgary. We also hope to conduct the study in Montreal. It is a challenge because we need installation dates of when everything is installed in order to be able to look at the effects of the infrastructure on the actual collision rates. 

Emily: What are some of the challenges or barriers when working on road traffic safety initiatives, including Vision Zero, with the municipality?

Linda: It has been an interesting journey. Researchers and municipalities have different perspectives on how we want to do things and what is important. We need to be able to communicate and speak each other's languages and I think it is the responsibility of the researcher to learn the municipality’s language, rather than the other way around. The more time you spend with the municipalities, surrounding yourself with the engineers, decision-makers, and the politicians making the decisions, the better. In order to make your research relevant and timely you need to be able to address the needs of the municipality that you are working with.  

One of the challenges is funding. Academic funding cycles and timelines are very different than municipal funding cycles and timelines. The municipality may be able to provide some money for a project but it is helpful to get additional funding through one of the tri-council grants (e.g., Canadian Institutes of Health Research [CIHR], Social Sciences and Humanities Research Council [SSHRC], Natural Sciences and Engineering Research Council [NSERC]). However, that granting process is extremely slow and politics move fast, more quickly than our funding cycles allow. So, there is a challenge of balancing the two. As academic researchers, a lot of our career is based on getting these grants and scientific publications, which does not always align with the needs of the municipality. 

The other challenge is the rigorousness of methods. We want randomized control trials because we want to be able to randomize which intersections get the intervention, which intersections don't get it, and we want to be able to have control locations. But in a municipality there are political and community priorities. It has become more apparent through the Vision Zero process that municipalities are really trying to hard make evidence-informed decisions but they are always influenced by the political necessity to implement interventions at certain sites. This does not work well with randomized control trials, so we have to be adaptable and there are other quasi-experimental designs that are more flexible. 

Another challenge is a lack of numbers. We (academics) want to have large numbers in our studies but sometimes the municipality only wants to study a few locations. So, we must look at different ways to evaluate, such as a process evaluation or qualitative research.

We also conducted a Vision Zero School Safety Zone study. We had our number of schools and then partway through the project the municipality got more money to add schools. So all of a sudden, your numbers have changed and your whole design is messed up. So, there are these methodological challenges and you have to work on being a flexible and adaptable researcher. 

There may also be differences in how interventions are defined. For example, the City and originally did the “lines and signs” even though there was no evidence-base to support their effectiveness. They really did not work great, and they still don't. So, by talking to your municipal partners they start to realize the value of having an evidence-base before you implement an intervention. However, sometimes things have to be done quickly, which is how municipal politics work. So, there is a bit of a push and pull... we need to spend money on things that actually work, but they might be a longer term solution and higher costs, which is a big issue.

The other important thing is evaluation. For example, we need our cycle tracks evaluated, so we ask “when were they installed?” I mentioned previously that the municipality may have a list of the years the tracks were installed, but not specific enough. In order to do a proper quantitative evaluation we need to know the actual dates of installation in order to know what happened before and after. Municipalities are not great at keeping track of those, which is a real challenge to getting evaluative research done with the municipalities.

Another challenge is agreeing with the municipality on the relevant outcomes. Collisions take a long time and you need a lot of post-intervention because, luckily, we do not get that many collisions. But collisions are a hard thing to measure if you have a short period of time. So, you need to negotiate the outcomes that the municipality is actually wanting to get and what they are going to do with those outcomes.

Emily: What are some things that help or facilitate this work moving forward? 

Linda: You have to start meeting right from the beginning of the project, and it is easiest when municipality comes to you and asks for help. It is not so easy the other way around. If you have great relationships with your municipal partners, they are probably amenable to ideas that are related, but you do need to meet together right at the beginning. It has to follow an integrated knowledge translation process and they have to be included in every step of the decision-making process. So, you need regular, strict regular meetings. With the automated speed enforcement project, the whole municipal and academic team were meeting every few weeks. This process builds relationships and develops a research study that makes sense to both of you. I think that's the most important message.

Emily: What is your advice for university or college researchers who are interested in working with municipalities and vice versa? 

Linda: It is really important to make yourself known to the municipalities and know who your team players are at the municipalities. For big cities like Toronto, which is who I tend to work with, there is a lot of change within the Transportation Department. People get moved around all the time or they move into different jobs. I attended the Ontario Traffic Council forum yesterday and I realized it is all the same players, just in different jobs now. So, it is important to remember who everybody is because it is likely you are going to end up working with that person again on a different project. Keeping track of who the player are and what they are doing is really important.

You also need to make yourself known. You need to get out there and not just sit behind your desk and write academic papers. You need to attend events like the Ontario Road Safety Forum. There are municipal representatives from all over Ontario at that forum. Go to conferences like CARSP, TAC (Transportation Association of Canada). These are things that the municipalities attend. I would try and present at as many of these as possible and as part of your presentation I would have a slide saying, “this is what I can do to help,” so they have some idea of who you are what you are able to do. Also, get involved in these organizations sit on their boards. Sit on a research planning committee, they want you there. It helps to make your research relevant and gives you excellent perspectives on what is happening on the ground. 

The other thing I would suggest is keeping your eyes open for funding calls both within and outside the university. Sometimes municipalities reach out directly to the universities. For example, the City of Toronto has an innovation challenge and they keep sending projects to TMU. The Ministry of Transportation Ontario (MTO) Road Safety Research Partnership Program is another, and the CIHR Healthy Cities program, which is focused on cities. Applying for that type of funding would really help as well.

Emily: Based on your experience, what would be one of the most effective Interventions for Road Safety?

Linda: It’s hard to actually pinpoint a specific one because I do think you need a program of research with many interventions. But a lot of it needs to be focused on speed and reducing speed. We know that speed is highly correlated with collisions. We know it is highly correlated with the severity collisions. The World Health Organization (WHO) has recommended 30 kilometers per hour speed limits where there are vulnerable road users. So, anything to reduce speed, such as traffic calming, automated speed enforcement, and reducing the posted speed limits. There is a lot of evidence to support these interventions. The most important target to be hitting is the reduction of speed. You can also work on separating vulnerable road users from traffic in terms of time and space with cycling infrastructure and some good pedestrian infrastructure. But the bottom line is to get that traffic speed down in urban areas, especially where there are vulnerable road users.

Emily: Is there anything else you would like to share?

Linda: For researchers, make yourself known to municipalities. Make sure they know and trust you. You might not think it is a great way to spend your time in terms of academic output, But it is really important to devote energy to engagement through a huge variety forms in the community and at the municipal level. Sometimes working with one municipality can lead to working with another municipality. Developing these relationships are absolutely necessary to ensure your research is relevant and can help make a difference.

Emily: Thank you Dr. Rothman for your time and sharing your experiences with our CARSP audience.