Why do child cyclists in the United States remain unhelmeted?

Abstract

The magnitude of bicycle-related head trauma and the protective value of helmets have been known for more than a decade, yet they are worn by all-too-few American children. The exact percentage is not known. In one survey conducted in 1991, the parents of 399 children under 15 years old reported that 26% owned or had use of a helmet, and that 15% wore the helmet “most or all of the time” while riding.1 In another survey conducted in 1994, the usage rate among children 5 to 14 years old was said to be 25%.2 Both studies depended on the reports of parents contacted through random-digit telephone dialing. Based on our own surveys indicating that parents substantially overreport helmet usage, we suspect that the actual rates are much lower. Other than in affluent neighborhoods, in most communities in the nation it is rare to see child cyclists wearing helmets. A successful national campaign, defined as inducing 70% of American schoolchildren to wear bicycle helmets, would result in more lives saved, more injuries prevented, and more long-term disability reduced than any other single injury control intervention available. That is because bicycle-related head injuries remain a relatively frequent and severe trauma problem for which an inexpensive (less than $20), and effective (85% reduction in risk of injury)3 intervention is readily available. Yet no such effort is currently on the planning board. What impels public health officials to launch intervention campaigns against some diseases or types of trauma and not against others? In 1993 4 children died as result of eating hamburger tainted with E coli 0157:H. As a result of these well-publicized deaths, lawsuits were successfully pursued, congressional hearings were held, and the Department of Agriculture proposed major changes in the handling and inspection of meat. Another swift …