Bicycle Helmet Use Research Articles

Children’s friends encourage use of bicycle helmets

Children’s friends encourage use of bicycle helmets

Parental knowledge and children's use of bicycle helmets.

Helmet use protects against head injury. Our objective was to assess whether parental knowledge of helmet safety is associated with helmet use in children, and whether a relationship exists between helmet ownership and other safety behaviors. Three hundred forty-one surveys were distributed to parents of third through fifth graders; 97% of parents believed that a helmet confers protection; 49% of parents reported that their child owns a helmet. Of the helmet owners, 27% reported that the child wears it more than 75% of the time. Seat belt usage was associated with helmet ownership (p=0.02) and frequency of wearing a helmet (p=0.04). Although parents are aware of the benefits, a barrier between helmet ownership and usage exists.

Introduction

Traumatic brain injury affects over 700,000 people in the United States each year. Of this number, about 75,000 will die of the immediate injury and an additional 90,000 will suffer long-term consequences, including the 20,000 who can be expected to subsequently develop epilepsy. These numbers are particularly impressive when one considers that those at highest risk, the young adult, will lose many productive years due to consequences of the condition. Population-based studies of newly diagnosed epilepsy suggest that up to 10% of all new cases can be attributed to traumatic brain injury. Cases affected with epilepsy are predominantly in the young adult population. There have been consistent efforts to reduce the frequency of traumatic brain injury. Primary prevention efforts include mandatory use of motorcycle helmets, seat belts, and bicycle helmets. The success of such programs is unclear, although the incidence of traumatic brain injury has fallen in the last 10 years. Better understanding of the epidemiology of traumatic brain injury may lead to other efforts in primary prevention. There has also been considerable effort to reduce the consequences of traumatic brain injury. Most notable have been efforts to intervene in the occurrence of posttraumatic epilepsy through early therapeutic interventions. To date, attempts at prophylaxis have been unsuccessful in preventing epilepsy, although there are some interventions that reduce the proportion of people with severe traumatic brain injury who experience seizures in the immediate period following the injury. In this supplement, we review the epidemiology of traumatic brain injury, the epidemiology of posttraumatic epilepsy, risk factors for posttraumatic epilepsy, and the justification for and results of studies of attempts to prevent posttraumatic epilepsy. We also present experimental data suggesting alternative methods of drug administration for prevention. Since there is a potential down side to any therapeutic intervention, we also discuss the impact of some antiseizure drugs on non-neuronal brain structures. We hope this review will provide insights into characteristics of posttraumatic epilepsy and stimulate further interest in both primary prevention of traumatic brain injury as well as the identification of intervention that may reduce or prevent the consequences of traumatic brain injury.

Inequalities in cycle helmet use: cross sectional survey in schools in deprived areas of Nottingham

Aims: To describe cycle helmet owning and wearing among children in a deprived area and to investigate the association between helmet ownership and wearing and socioeconomic deprivation. Methods: Cross sectional...

Influence of socioeconomic status on the effectiveness of bicycle helmet legislation for children: a prospective observational study.

Influence of socioeconomic status on the effectiveness of bicycle helmet legislation for children: a prospective observational study.

Bicycle helmet assessment during well visits reveals severe shortcomings in condition and fit.

Improper bicycle helmet fit increases the risk of head injury. Information on the rate of proper use of bicycle helmets is lacking. Promotion of helmet use is recommended at well-child and adolescent visits. Actual helmet assessment during such visits has not been reported. The primary goal of this study is to measure the proportion of children whose helmets are in proper condition and can be made to fit properly by the child and/or parent. The secondary goal is to begin to assess the value and practicality of helmet inspection during well-child and adolescent visits. The study took place at a private pediatric office in Falmouth, Massachusetts, from June 1 through August 31, 2001. Eligible children and adolescents were those aged 4 to 18 years presenting for well examination, along with siblings present at the visit. Eligible families completed a questionnaire, then had a timed attempt to fit a helmet, followed by an assessment of helmet fit and condition against a predetermined standard. Eighty-four percent (395/473) of eligible families participated. A total of 479 participants were assessed. Eighty-eight percent of participants (419/478) owned a helmet. Reported helmet use "always" or "almost always" was 73% for bicycling (317/434), 69% for in-line skating (193/279), 58% for scootering (179/310), and 50% for skateboarding (79/158). Compared with younger children, teenagers were less likely to wear helmets for all activities. Complete pass rate for every aspect of condition and fit was 4% (20/478, 95% confidence interval: 3-6). The pass rate when the parent alone fit the helmet was 0% (0/52). Three individual aspects of fit were most problematic: 1) helmet 'resting position' too high on the forehead (pass rate 249/479; 52%), 2) improper strap position (pass rate 157/476; 33%), and 3) excessive movement of the helmet from front to back of the head (pass rate 247/479; 52%). Mean time for questionnaire completion was 4 (standard deviation: +/-1) minutes, and 7 (standard deviation: +/-3) minutes for helmet assessment. Ninety-six percent of children and adolescents wore helmets in inadequate condition and/or with inadequate fit. This occurred despite a high acceptance of helmet use by this population. Initial evidence suggests that helmet assessment during well visits may be practical and valuable.

Evaluation of interventions designed to prevent and control injuries.

Violent and unintentional injuries place a severe physical, emotional, and financial burden on US communities. Injuries affect people of all ages, from infants through older adults, and are the leading cause of death in the first four decades of life (1). In 1995, the economic cost of injuries was estimated to be over $260 billion, including the costs of health care and lost productivity (2). Despite the large burden on US communities, injury prevention is still a relatively new area of public health. In 1992, Congress mandated the establishment of the Centers for Disease Control and Prevention’s National Center for Injury Prevention and Control to coordinate research and programmatic responses to the problem of injuries in this country (3). In partnership with other federal, state, and local organizations and universities, the Center has encouraged the use of a population-based or public health approach to injury research and programs. This approach complements engineering, mental health, and criminal justice approaches to injury prevention and control. Evaluation of interventions is an important aspect of injury prevention. Results of evaluations have the power to change injury prevention practice. For example, bicycle helmet use increased following demonstration of the impact of helmets on brain injury (4–6). The number of programs promoting installation of smoke detectors and provision of fire injury prevention education grew once these programs were shown to be highly effective and to save money (7, 8). The number of states with laws prohibiting blood alcohol concentrations of 0.08 percent or higher increased after such laws were shown to decrease fatal motor vehicle injuries (9–11).

The Use of Bicycle Helmets in a Western Canadian Province Without Legislation

Introduction: This study examined the use of helmets in adults, adolescents, and children in a western Canadian province that has no helmet legislation. Methods: A prospective survey of cyclists in two urban Alberta regions was completed. Cyclist demographics, helmet wearing and helmet use were recorded. Results: Helmets were observed in 2,259 (55%; 99% CI: 52–57) of 4,141 cyclists; however, only 75% (CI 71, 78) were wearing the helmet properly. Patterns of use varied according to age: 75% (CI 71, 78) of children, 29% (CI 23, 34) of adolescents, and 52% (CI 49, 55) of adults wore helmets. Percentages were higher in Calgary than Edmonton (63% vs. 45%; p<0.0001) and females wore helmets more often (64% vs. 50%; p<0.0001). Discussion: These results identify large within- and between-region variation in the use of cycling helmets in Alberta. Injury prevention planners need to use these data to adopt interventions that are focused on age groupings, gender, and place of residence

A Bicycle Safety Education Program for Parents of Young Children

This study examined parental perceptions of the benefits and barriers to bicycle helmet use and their level of knowledge about bicycle safety issues. A school-based bicycle safety education program was taught to first- and second-grade students in a rural/suburban school district by a graduate nursing student. Pender’s Health Promotion Model was the theoretical framework used to guide this research study. A parent Bicycle Helmet Questionnaire (BHQ) developed by the author was the tool used to gather data. The study determined that parents of children in schools that received the educational intervention prior to completing the questionnaire had significantly higher knowledge level scores and that the majority of parents were in favor of bicycle helmet legislation for children. The implications from this research study include the importance of bicycle safety education interventions for students and parents and the need to implement bicycle helmet legislation.

Bicycle Helmet-wearing Variation and Associated Factors in Ontario Teenagers and Adults

The incidence of bicycle helmet use and the factors associated with helmet use in Ontario are presented in this study. The Ontario Health Survey (1996), a population-based survey of Ontario residents, was used as the data source.As the factors associated with helmet use were found to differ between adults and teens, a separate analysis was performed for each age grouping. A logistic regression model (with Bootstrap confidence intervals--95%) was used and adjusted odds ratios (OR) are reported.Of the 7,693 respondents, 41.1% reported wearing their helmets on a regular basis when riding a bicycle. Helmet use was greatest among 12-14 year olds (71.7%) and lowest among those 15-18 years old (33.3%). In teenagers, drinking alcohol (OR: 2.8) and smoking (OR: 4.4) were strongly associated with helmet non-use. In the adult group, female gender (OR: 1.26), higher income (OR: 1.43), higher education (OR: 1.68), nonsmoking status (OR: 2.0) and abstinence from alcohol (1.27) were associated with helmet use. Living in a rural area was also associated with helmet use in the multi-variable analysis.This study indicates that bicycle helmet non-use is a multifaceted problem and thus any strategy for increasing helmet-wearing rates requires multi-dimensional interventions. The results of this study are discussed within the context of other studies and related to their public health implications.

State level estimates of the incidence and economic burden of head injuries stemming from non-universal use of bicycle helmets

Objective: To develop national and state level estimates for preventable bicycle related head injuries (BRHIs) and associated direct and indirect health costs from the failure to use bicycle helmets. Methods:...

Effects of state helmet laws on bicycle helmet use by children and adolescents

Objective: To evaluate the effectiveness of state helmet laws in increasing the use of bicycle helmets by children and adolescents under age 16. Setting: United States. Methods: A cross sectional...

Promotion of Safety Helmets for Child Bicyclists: 2002 Update

Current research continues to show that bicycle helmets prevent serious injury and death in cyclists of all ages. Children are at special risk for head injury. The purpose of this review was to update information on the use and protective effect of bicycle helmets for child cyclists. Legislation, combined with community education and helmet promotion campaigns, remains the most cost-effective approach for increasing helmet use. Nineteen states and the District of Columbia have passed helmet legislation. Modest gains in helmet-wearing rates have been documented, with the greatest gains in young children, compared with adolescents. Nurses remain in strategic positions to encourage helmet use by educating children and parents. Nurses can participate in community-based education and advocacy programs. Nurse researchers can carry out descriptive studies that increase community awareness of bicycle injuries and examine factors such as parental rules and adolescent risk-taking.

Effectiveness of a state law mandating use of bicycle helmets among children: an observational evaluation.

In spring 1999, the authors evaluated the effectiveness of a 1997 Florida law requiring helmet use by all bicyclists younger than age 16 years. Sixty-four counties in Florida had enacted the bicycle helmet-use law, while the other three counties had opted out. Using a cross-sectional study design, the authors conducted unobtrusive observations at bicycle racks at public elementary schools statewide. Florida children riding bicycles in counties where the state helmet-use law was in place were twice as likely to wear helmets as children in counties without the law. In counties where the state law was in place, 16,907 (79%) of 21,313 riders observed wore a helmet, compared with only 148 (33%) of 450 riders in counties where no such law was in place (crude prevalence ratio = 2.4, 95% confidence interval: 2.1, 2.8). Helmet use by children of all racial groups exceeded 60% under the law. No significant difference in use by gender was found. These data support the positive influence of a law on bicycle helmet use among children. The data reinforce the Healthy People 2010 objective that all 50 states adopt such a law for children in order to increase helmet use and consequently reduce brain injury.

Increasing the use of bicycle helmets: lessons from behavioral science

Bicycle helmet purchase, use, consistent use, and correct use are determined by a complex set of factors. Behavioral theory suggests that they are influenced by the reciprocal association between individual characteristics such as, expectations, skills, attitudes, and beliefs; social influences such as social norms and peer pressure; and environmental factors such as availability, accessibility, and cost. These factors can be influenced through counseling and other interventions. While a review of the literature suggests that many bicycle helmet programs have not been planned using behavioral models and knowledge from the behavioral sciences, many studies include information that supports behavioral principles. This paper describes the behavioral principles and their application to the problem of increasing bicycle helmet use. Recommendations for practitioners are included.

Why teenagers owning a bicycle helmet do not use their helmets

Problem: Recent reports about bicycle helmet wearing indicate that the number of helmet users is still very small among teenagers. The objective of this prevalence survey was to investigate why teenagers do not use a bicycle helmet even if they have one. Method: Data were collected at two schools in Helsinki, Finland. High school students ( N=965) completed a questionnaire about their cycling habits and bicycle helmet use. Results: A student's parents' positive attitude to bicycle helmet use was the strongest predictor of having a helmet. Analyses of responses given by bicycle helmet owners showed that having friends who use a bicycle helmet is strongly related to a student's decision to wear a helmet. In addition, parents' positive opinion to helmet wearing predicted helmet use frequency. Other factors accounted only for a small proportion of variance in helmet wearing frequency. Summary and Impact on Industry: The present study shows that the most efficient way of increasing bicycle helmet-wearing rate among students is to influence peer opinions and to inform students' parents about the safety benefits of bicycle helmets, which should be taken into account when planning bicycle helmet-wearing campaigns and other countermeasures.

Bicycle helmet use among schoolchildren—the influence of parental involvement and children's attitudes

Objective—To study attitudes towards and use of bicycle helmets among schoolchildren; to determine whether these attitudes are associated with the involvement of parents and school in bike safety. Settings—Nine intermediate...

Associations between adult and child bicycle helmet use.

To observe the incidence of proper and improper use or non-use of bicycle helmets by children and adults when riding bicycles in groups. An observational survey of bicycle riders on a recreational bicycle path. In eight half-day sessions, two observers independently rated all riders in groups that consisted of adults and children either wearing or not wearing helmets. Those who wore helmets were then rated as wearing them properly or improperly. Two-thirds of children wore helmets, but less than one-half wore them properly. One third of the adults wore helmets, and one-half of those wore them properly. Adult helmet use affected child helmet negatively. The strongest correlations were between adult helmet use or non-use and improper or no helmet use in accompanying children. Primary care nurses who work with healthy populations should collaborate with other groups involved with families to not only exhort them to wear helmets when riding bicycles but also to instruct those riders how to wear their helmets properly.

Barriers to bicycle helmet use.

To determine why people do or do not wear helmets while bicycling. A survey was conducted from August through October 1999. Two survey areas were chosen for this study: local public schools and paved bicycle trails. For the school arm of the study, 3 public elementary, middle, and high schools were selected from 3 different regions of Rochester, Minnesota, for participation in the study. For the bicycle arm of the study, 3 paved trails located in southeastern Minnesota were selected. A total of 2970 surveys were distributed to the public school system, and 463 surveys were collected from bicyclists on the paved bicycle trails. The survey population was split into 3 age categories for analysis: child (7-10), adolescent (11-19), and adult (older than 19). Of the 2970 surveys distributed to Rochester public schools, 2039 (69%) were returned for analysis. Seventy-eight of the surveys that were completed in the public school system were discarded for the following reasons: age <10 years (35), insufficient completion (24), and selection of every reason for not wearing a bicycle helmet (19). A total of 463 surveys were completed on the 3 paved bicycle trails. One survey from the paved bicycle trail arm of the study was discarded because of insufficient completion. The total number of surveys used for statistical analysis was 2424. The distribution of male (52.7%) and female (47.3%) participants was similar. No significant difference in bicycle helmet use was found between genders. The age groups with the highest rate of bicycle helmet use were 50 to 59 years (62%) and older than 59 years (70%). The age groups with the lowest rate of bicycle helmet use were 11 to 19 years (31%) and 30 to 39 years (30%). The most common reasons given for not wearing a bicycle helmet were "uncomfortable," "annoying," "it's hot," "don't need it," and "don't own one." Bicycle helmet use was significantly influenced by peer helmet use in all 3 age groups. Children also were more likely to wear a bicycle helmet when their parents wore bicycle helmets. A majority of respondents in all 3 age groups indicated that bicycle helmets provided either "moderate" or "great" protection from head injury, although significantly more adults (65.9%) than adolescents (43.9%) believed that the protection afforded by bicycle helmets was "great." Despite this belief, a majority of adolescents and adults indicated that there was only a "slight risk" of head injury when bicycling without a helmet. Participants in all 3 categories were more likely to wear a bicycle helmet when they indicated either that there was a "great risk" of head injury when bicycling without a helmet or that helmets provided "great protection" from head injury. Adolescents and adults who believed that bicycling without a helmet put one at "great risk" for head injury also were more likely to indicate that helmets provided "great protection" from head injury. The prevalence of bicycle helmet use remains low despite research indicating the high level of head injury risk when bicycling without a helmet and the significant protection afforded by bicycle helmets. With the information provided by this survey, a well-designed intervention to increase the use of bicycle helmets can be implemented. Suggestions for a campaign to promote an increase in bicycle helmet use include focusing efforts on males and females between 11 and 19 years and 30 and 39 years of age; educating the public on new bicycle helmet designs that address comfort, ventilation, and fashion; educating adolescents on the significant protection from head injury afforded by bicycle helmets; and educating the public on the risk and severity of head injury associated with bicycling without a helmet. The influence of parents and peers on bicycle helmet use may be targeted through education and statements such as, "If you wear a bicycle helmet, you are not only protecting yourself, you are also helping to protect your friends and/or children." bicycle, helmet, injury, accident, prevention.

Correlation between parental perception and actual childhood patterns of bicycle helmet use and riding practices: Implications for designing injury prevention strategies

Background/Purpose: Bicycle injuries account for 10% of all pediatric traumatic deaths. Bicycle helmets have proven to decrease morbidity and mortality, yet trauma data show low helmet use among injured children. However, owning a bicycle helmet does not universally result in a child wearing a helmet. Furthermore, we hypothesize that parental perception of their children's use of the bicycle helmet may not reflect accurately true utilization by their child. To investigate this hypothesis the authors examined both parents' and their children's reports of bicycle ownership, supervision, riding patterns, and helmet use. Methods: A random sample of grade 5 and 6 students (ages 8 to 12) and their parents were surveyed about bicycle ownership, riding patterns, supervision, and helmet use. The children and their guardians responded independently to the questionnaire. Statistical analysis was performed using the χ2 test when indicated. Results: Eighty-eight of 102 children (86%) responded. This represented 56% girls and 44% boys aged 8 to 12 years. Sixty-nine of 90 (77%) of the parents returned the survey. Ninety-six percent of the children owned a bicycle. A total of 87.5% of children owned a bicycle helmet. Eighty percent of the time children ride their bicycles on the road or sidewalk, with less then 20% on marked trails or parks. Parents reported that their children wear a helmet 90% of the time. In contrast, children report no helmet use in up to 61% of riding instances (P <.05). Parents themselves do not wear a helmet in greater then 60% when riding, which is correlated by their children. Seventy-one percent of the children report that they ride unsupervised the majority of the time. Conclusions: Bicycle and bicycle helmet ownership is high among this study group. There is a significant possibility that children will ride unsupervised, in at-risk situations, without wearing a helmet. Parental perceptions about bicycle helmet use by their children may not accurately reflect true utilization. In this study group parents appear as poor role models for their children. Injury prevention strategies need to focus on children and adults to improve effectiveness. J Pediatr Surg 36:763-766. Copyright © 2001 by W.B. Saunders Company.