Bicycle Helmet Use Research Articles

Sağlık İnanç Modeli Temelli Bisiklet Kaskı Tutum Ölçeği'nin Türkçe Versiyonunun Üniversite Öğrencilerinde Geçerlik ve Güvenirliği

Objective: Measuring health beliefs and attitudes that support bicycle helmet use assists healthcare professionals in increasing the use. This study aimed to provide the Turkish society with an instrument that can measure students' attitudes related to health beliefs in bicycle helmet use and to analyze its validity-reliability. Material and Methods: This methodological research was carried out in psychological counseling and guidance department of Pamukkale University in Turkey among students between January and March 2019 (n=326). The data were collected in face-to-face interviews with the socio-demographic question form and the Bicycle Helmet Attitudes Scale. Internal consistency coefficient and test-retest analyses were used for the reliability of the scale, and content validity index and confirmatory factor analyses for its validity. Results: Turkish form of the scale is composed of 56 items and 10 factors. Cronbach alpha values of the sub-dimensions ranged from 0.70 to 0.88. The confirmatory factor analysis concluded χ2/df=2.18; root mean square error of approximation=0.06; comparative fit index=0.94; incremental fit index=0.94. The test-retest correlation value of the sub-dimensions is between 0.50 and 1.00. The confirmatory factor analysis showed acceptable values and acceptable fit for the model fit statistics. Conclusion: Turkish form is an instrument with sufficient validity and reliability indicators. The Turkish form which can be easily applied to individuals of all age groups can determine health belief levels associated with individuals' bicycle helmet use and identify vulnerability, severity, benefit, barrier and cues to action.

Bicycle Helmets and Bicycle-Related Traumatic Brain Injury in the Netherlands.

The aim of this study was to determine the association between bicycle helmet use in adults (16 years and older) and traumatic brain injury (TBI) in emergency departments (EDs) in the Netherlands.The conducted research was a retrospective case-control study in patients aged 16 years and older who sustained a bicycle accident and therefore visited the EDs of participating hospitals throughout 2016. Cases were patients with TBI; controls were patients without TBI but with other trauma. Exposure was defined as helmet wearing during the accident. In total, 2133 patients were included in the study, 361 case patients and 1772 controls. Within the TBI group (cases) 3.9% of patients wore a helmet compared with 7.7% of patients in the control (non-head injury) group (odds ratio [OR] 0.49, 95% confidence interval [CI]: 0.28-0.86). No difference in helmet wearing was observed in patients who sustained accidents that involved motorized vehicles (OR 0.91; 95% CI: 0.29-2.83). In conclusion, adult patients (≥16 years of age) with TBI had a significantly lower odds of wearing a bicycle helmet than adult patients with other trauma, adding more evidence that wearing a bicycle helmet effectively protects against TBI.

자전거 헬멧 착용의 연관 요인: 다수준분석

Objectives: This study sought to identify factors associated with bicycle helmet use at both individual and regional levels. Methods: We analyzed data from community health surveys conducted in 2016 in 254 municipal districts (si, gun, and gu) by the Korea Center for Disease Control. In total, 49,105 bicycle riders were enrolled from among the 228,452 adults systematically sampled using the resident registration database. Regional (municipal)-level data were provided by K-Health ranking (Hallym University, South Korea), which represents a collection of indicators processed from various sources. Multilevel binary logistic regression analysis was performed for the dependent variable, a self-reported response of "I always wear a helmet." Results: The percentage of bicycle helmet use was 13.7% among men and 6.2% among women. Regional-level factors accounted for 11% and 10% of the variance of bicycle helmet use among men and women, respectively. Among regional variables, the proportion (%) of the population that was elderly significantly decreased the odds of helmet use (adjusted odds ratio [AOR] = 0.97, 95% confidence interval [CI], 0.95-0.98 for men; AOR = 0.96, 95% CI, 0.94-0.98 for women). Conclusion: Community efforts to promote bicycle helmet use are needed, especially in areas with a large elderly population.

Are helmeted cyclists taking more risk at signalized intersections?

Objective The aim of the present study was to investigate the relationship between bicycle helmet use and safety behavior at signalized intersections. Two hypotheses were investigated: The first states that bicycle helmet use leads to risker behavior because of the increased sense of protection (risk compensation), the other states that helmeted cyclists have a general inclination toward safer behavior (safety package) and that helmet use is one of several behaviors for improving safety. Method Based on video recordings of 1031 cyclists at 12 signalized intersections in Denmark, two indicators of risky behavior were compared between helmeted and unhelmeted cyclists: Speed and time after the onset of yellow at which the cyclists crossed the stop line. Linear regression models were developed with gender, type of bicycle, and intersection characteristics as predictor variables, in addition to helmet use. Results Helmeted and unhelmeted cyclists do not differ in how many seconds after the onset of yellow they cross the stopping line. This is consistent with the absence of both risk compensation and safety package, alternatively with a general inclination of helmeted cyclists toward safer behavior which is about offset by risk compensation. Helmeted cyclists had higher speed on average, which indicates that risk compensation may occur. However, the higher speed may also be due to the generally better fitness of helmeted cyclists which is likely to result from larger cycling volumes. Moreover, the effect of helmet use on speed may be overestimated because of a lack of control for potential confounding variables. The results show further that, regardless of helmet use, before-red (lights on a separate bicycle signal shift to red before the main signal) is related to later crossings of the stop lane after the onset of yellow and that cyclists stop earlier on average at intersections with right-turn signals. Conclusions The results do not provide support for the position that promoting or mandating bicycle helmet use will have adverse safety effects because of more risky behavior among helmeted cyclists.

The perspectives of young people on barriers to and facilitators of bicycle helmet and booster seat use.

Mandatory bicycle helmet and booster seat laws for children are now common across Canada and the United States. Previous research has found that despite legislation, child compliance is often low. Our objectives were to identify and compare children's perspectives on barriers to and facilitators of their use of bicycle helmets and booster seats. Eleven focus groups were conducted with a total of 76 children; five groups of children between the ages of 4 and 8 years discussed booster seats and bicycle helmets, and six groups of children between the ages of 9 and 13 years discussed bicycle helmets. Efforts were made to include diverse participants from a variety of ethno-cultural and socioeconomic backgrounds. Poor fit and physical discomfort were most often described as barriers to bicycle helmet use. Helmet appearance was a barrier for some children but acted as a facilitator for others. Booster seat facilitators included convenient features such as drink cup holders and being able to sit higher up in order to have a better view, while barriers included fear of being teased, and wanting to feel and be seen as more mature by wearing a seatbelt only. The main barriers to usage of bicycle helmets and booster seats identified by young people were modifiable and fit within a theory of planned behaviour framework that includes subjective norms, child attitudes towards safety equipment and perceived behavioural control of its usage. Recommendations were made regarding how these elements can be utilized in future injury prevention campaigns.

Evaluation of a Culturally Tailored Educational Video Intervention to Promote Bike Helmet Safety for Urban Children: A Pilot Study.

Bicycle-related falls are a significant cause of mortality and morbidity. Use of bicycle helmets substantially reduces risk of severe traumatic brain injury but compliance with this safety practice is particularly low in urban children. Given the lack of educational interventions for urban youth, our research team created a youth-informed, culturally relevant educational video on bike helmet safety, which was informed by focus groups with Baltimore City youth. This video, You Make the Call, linked the concept of use of cases to protect phones to use of helmets to protect heads and can be viewed at http://bit.ly/2Kr7UCN. The impact of the video as part of an intervention (coupled with a free helmet, fit instructions, and a parent guidance document) was tested with 20 parent-child dyads. The majority (80%) of youth (mean age 9.9 ± 1.8 years) reported not owning or wearing a helmet. At 1-month follow-up (n = 12, 60% response rate), helmet use was higher in the five youth reporting bike-riding after the intervention; 100% "always" used helmets compared to 0% preintervention. There were increases in youth reporting that parents required helmet use (35% pre vs. 67% post) and that is was possible to fall when bike-riding (60% pre vs. 92% post). These pilot results support the use of this video and educational intervention along with further evaluation in a larger sample size. This youth-informed and culturally tailored approach could be explored as a strategy to address other pediatric injury topics.

More than just the helmet: The relationship between bicycle helmet use and non-bicycling risk-taking behaviors among American adolescents

Adolescents engage in more risky behaviors than other age groups, including riding a bicycle without a helmet. To address helmet use, public health professionals encourage it, even passing laws requiring helmet use. But these approaches may have unintended consequences, potentially pushing more risk-prone adolescents away from riding a bike and into cars. This mode shift could lead to worse safety outcomes, not just for teens but for society in general, as a risk-prone teen driver would be more dangerous to themselves and society behind the wheel of a car than when riding a bicycle. This research is a first-step in addressing the complicated issues around helmet promotion by asking the question: are risky non-bicycling behaviors associated with bicycling and wearing a helmet while bicycling among adolescents? We test correlations between non-bicycling risk-taking behaviors (such as drug and alcohol use), bicycling, and bicycle helmet use in a generalizable sample of US adolescents.Data comes from a nationally-representative sample of 15,624 US high school students collected in 2015. Findings from a multinomial logistic regression model and analysis of variance identify a sample population consisting of at least three distinct groups: i) a non-bicycle-riding group; ii) one bicycle-riding group that tends not to wear a helmet and reports increased risky non-bicycling behaviors; and iii) another bicycle-riding group that tends to wear a helmet and engages in few risky non-bicycling behaviors. Furthermore, we do not find evidence for helmet-wearing adolescents who are also risk-takers, nor do we find evidence for non-risk-taking adolescents that do not wear helmets. The group that does not bicycle is generally older than the bicycle riding groups and is characterized by more risky non-riding behaviors than the helmet wearing group (but fewer risky behaviors than the group that bicycles but does not wear a helmet). Our results indicate that individual behavioral characteristics require increased attention in helmet use and bicycle safety research.

P096: Non-legislative interventions to promote helmet use in adult cyclists: a scoping review

Introduction: Helmets are effective in preventing brain injury and fatality in cyclists. Methods to promote their use include legislation and non-legislative interventions (NLIs) such as education, social interventions, and subsidies. These have been systematically reviewed and proven effective in pediatric populations. We conducted a scoping review regarding NLIs to promote helmet use amongst adult cyclists. Methods: We conducted a scoping review of NLIs to promote helmet use amongst cyclists age 18 or older. PRISMA guidelines were followed. Databases searched included MEDLINE, EMBASE, CINAHL, PsycINFO, and SportDiscus, in addition to grey literature. Articles were excluded if non-English, focused on age <18, on legislative interventions, or did not report on outcomes related to helmet use or ownership. Study inclusion and data extraction were conducted in duplicate. Data were extracted regarding participant demographics, setting, intervention details and effects, and were reported using descriptive statistics with a narrative synthesis. A limited quality assessment was conducted. Results: A total of 16 papers were included, stratified as 4 randomized-controlled trials and 12 pre-post studies. Only 4 were specific to adults. Community cyclists (5/16, 31%) and community members were most commonly targeted, with most interventions taking place in the community (8/16, 50%) or in a healthcare setting (4/16, 25%). Most interventions were multi-faceted, involving components of community awareness programs, education, information distribution, helmet giveaways and monetary incentives, use of mass media, motivational interviewing, and social marketing. The studies were heterogeneous in quality. Changes in helmet rate use varied between -6% and 26%, with half the studies (8/16, 50%) noting a statistically significant increase. Duration of follow-up of helmet use rates following the intervention varied between 4.5 weeks and 11 years (median 1.38 years, mean 3.0 years.) Conclusion: NLIs to encourage bicycle helmet use were frequently multi-faceted and generally associated with an increase in use amongst adults. Studies were heterogenous in quality, varied in their targeted audiences and often not focused on adults. Further evidence is needed to better characterize the efficacy of non-legislative interventions to achieve sustained helmet use in adult cyclists.

A comparison of parent and child perspectives about barriers to and facilitators of bicycle helmet and booster seat use

To date, little work has compared similarities and differences between parent and young people’s perceptions of barriers to and facilitators of bicycle helmet and booster seat usage. Our goal was to conduct such a comparison in order to inform future safety campaigns. Eleven focus groups with a total of 68 parents and 11 focus groups with a total of 76 young people were conducted. Recruitment was conducted and focus groups were held in diverse neighbourhoods to facilitate participation by families from a variety of cultural, linguistic, and socioeconomic backgrounds. Overall, parents and their children agreed on 50% of the barriers identified for bicycle helmet use and approximately 40% of the barriers for booster seats. Barriers common to both types of equipment for parents and children included comfort, style and design, and fear of teasing. Common facilitators included perceived safety, and comfort. While there was considerable overlap between the perspectives of parents and young people, there were also differences, underscoring the importance of addressing both perspectives. The barriers and facilitators identified were modifiable to a large extent; based on these, recommendations for future injury prevention campaigns were outlined.

Cost-effectiveness of mandatory bicycle helmet use to prevent traumatic brain injuries and death

BackgroundTraumatic brain injury (TBI) is the main cause of mortality and severe morbidity in cyclists admitted to Dutch emergency departments (EDs). Although the use of bicycle helmets is an effective way of preventing TBI, this is uncommon in the Netherlands. An option to increase its use is through a legal enforcement. However, little is known about the cost-effectiveness of such mandatory use of helmets in the Dutch context.The current study aimed to assess the cost-effectiveness of a law that enforces helmet use to reduce TBI and TBI-related mortality.MethodsThe cost-effectiveness was estimated through decision tree modelling. In this study, wearing bicycle helmets enforced by law was compared with the current situation of infrequent voluntary helmet use. The total Dutch cycling population, consisting of 13.5 million people, was included in the model. Model data and parameters were obtained from Statistics Netherlands, the National Road Traffic Database, Dutch Injury Surveillance System, and literature. Effects included were numbers of TBI, death, and disability-adjusted life years (DALY). Costs included were healthcare costs, costs of productivity losses, and helmet costs. Sensitivity analysis was performed to assess which parameter had the largest influence on the incremental cost-effectiveness ratio (ICER).ResultsThe intervention would lead to an estimated reduction of 2942 cases of TBI and 46 deaths.Overall, the incremental costs per 1) death averted, 2) per TBI averted, and 3) per DALY averted were estimated at 1) € 2,002,766, 2) € 31,028 and 3) € 28,465, respectively. Most favorable were the incremental costs per DALY in the 65+ age group: € 17,775.ConclusionsThe overall costs per DALY averted surpassed the Dutch willingness to pay threshold value of € 20,000 for cost-effectiveness of preventive interventions. However, the cost per DALY averted for the elderly was below this threshold, indicating that in this age group largest effects can be reached. If the price of a helmet would reduce by 20%, which is non-hypothetical in a situation of large-scale purchases and use of these helmets, the introduction of this regulation would result in an intervention that is almost cost-effective in all age groups.

Association of helmet use with traumatic brain and cervical spine injuries following bicycle crashes

Background: The use of bicycle helmets in preventing traumatic brain injuries (TBI) is frequently cited but data remain inconclusive. Additionally, the effects of helmets on cervical spine injuries (CSI) are debated.Methods: We performed a retrospective review of all adult patients with bicycle crashes presenting to one level 1 trauma center in Wisconsin from 2010 to 2016. Patients were divided into two groups: helmeted and un-helmeted.Results: In total 287 patients were included; 149 un-helmeted (51.9%) and 138 helmeted (48.9%). Helmeted riders had radiographic evidence of traumatic brain injury in 20.3% of cases compared to 40.3% of un-helmeted (p < 0.001). On average, helmeted riders had a similar injury severity score of 7.80 (standard deviation (SD) = 7.18) compared with 8.25 (SD = 9.98) in the un-helmeted group (p = 0.68). CSI occurred in 16 (10.7%) un-helmeted patients compared with 15 (10.9%) helmeted patients (p = 0.707). Of the un-helmeted group, four patients (2.7%) were found to have a cervical spine fracture compared with 12 (8.7%) helmeted patients (p = 0.037).Conclusion: Helmet use demonstrated a statistically significant advantage in the prevention of traumatic brain injuries. No significant difference was found regarding the incidence of severity of cervical spine injuries. These results do not demonstrate any statistically significant benefit in the prevention of cervical spine injuries with helmet use. In contrast, helmet use was found to convey a significant protective advantage in the prevention of traumatic brain injuries compared to no helmets.

Pediatric Traumatic Brain Injury in the United States: Rural-Urban Disparities and Considerations.

Introduction: Traumatic brain injury (TBI) remains a primary cause of pediatric morbidity. The improved characterization of healthcare disparities for pediatric TBI in United States (U.S.) rural communities is needed to advance care. Methods: The PubMed database was queried using keywords ((“brain/head trauma” OR “brain/head injury”) AND “rural/underserved” AND “pediatric/child”). All qualifying articles focusing on rural pediatric TBI, including the subtopics epidemiology (N = 3), intervention/healthcare cost (N = 6), and prevention (N = 1), were reviewed. Results: Rural pediatric TBIs were more likely to have increased trauma and head injury severity, with higher-velocity mechanisms (e.g., motor vehicle collisions). Rural patients were at risk of delays in care due to protracted transport times, inclement weather, and mis-triage to non-trauma centers. They were also more likely than urban patients to be unnecessarily transferred to another hospital, incurring greater costs. In general, rural centers had decreased access to mental health and/or specialist care, while the average healthcare costs were greater. Prevention efforts, such as mandating bicycle helmet use through education by the police department, showed improved compliance in children aged 5–12 years. Conclusions: U.S. rural pediatric patients are at higher risk of dangerous injury mechanisms, trauma severity, and TBI severity compared to urban. The barriers to care include protracted transport times, transfer to less-resourced centers, increased healthcare costs, missing data, and decreased access to mental health and/or specialty care during hospitalization and follow-up. Preventative efforts can be successful and will require an improved multidisciplinary awareness and education.

Adoption of municipal bylaw legislating mandatory helmet use for cyclists under the age of 18: impact on cycling and helmet use.

Bicycle helmet use is recognized as an effective way to prevent head injuries in cyclists. A number of countries have introduced legislation to make helmets mandatory, but many object to this type of measure for fear that it could discourage people, particularly teenagers, from cycling. In 2011, the City of Sherbrooke adopted a bylaw requiring minors to wear a bicycle helmet. The objective of this study was to assess the impact of this bylaw on cycling and bicycle helmet use. The impact of the bylaw was measured by comparing the evolution of bicycle helmet use among youth aged 12 to 17 years in the Sherbrooke area (n = 248) and in three control regions (n = 767), through the use of logistic regression analyses. Cycling rates remained stable in the Sherbrooke area (going from 49.9% to 53.8%) but decreased in the control regions (going from 59.1% to 46.3%). This difference in evolution shows that cycling rates increased in the Sherbrooke area after the adoption of the bylaw, compared to the control regions (odds ratio [OR] of the interaction term: 2.32; 95% confidence interval [CI]: 1.01-5.35). With respect to helmet use, a non-statistically significant upward trend was observed in the Sherbrooke area (going from 43.5% to 60.6%). This figure remained stable in the control regions (going from 41.5% to 41.9%). No significant difference was observed in the evolution of helmet use between the two groups (OR of the interaction term of 2.70; 95% CI: 0.67-10.83). After the bylaw was adopted, bicycle use among youth aged 12 to 17 years in the Sherbrooke area remained stable and helmet used increased, though not significantly.

Accident typology comparisons between pedelecs and conventional bicycles

The data from the years 2009 until 2015, collected by a scientific research team at the Hannover Medical School for the GIDAS project (German In-Depth Accident Study), were used as the study sample. Results: Injuries do not occur more often or more seriously in pedelec accidents than in conventional bicycle accidents. For accidents involving pedelec riders, almost exclusively injury severities of MAIS 1 and 2 (slight/moderate) can be observed and only one case of severe injury (MAIS 3), whereas for accidents with conventional bicyclists (Maximal Accident Injury Severity) MAIS 3+ occurs more often with 4.3%. The statistical analysis shows that head injuries occur more often in pedelec accidents (42.2%) compared to conventional bicycle accidents (35.7%). In addition, there are 21.8% more driving accidents (i.e., single-vehicle accidents such as collisions against objects or falls) involving pedelecs compared to 12.0% for conventional bicycle accidents. Finally, this study shows that pedelec riders tend to be much older than bicyclists, and the injury pattern of bicyclists and pedelec riders seems to depend on the age of the rider: with increasing age a rising risk of head injuries occurs and, therefore, the use of bicycle helmets is an important factor for injury prevention.

Promoting Bike Helmet Safety for Urban Children Through a Culturally Tailored Educational Video Intervention

Bicycle-related falls are a significant cause of mortality and morbidity. Use of bicycle helmets substantially reduces risk of severe traumatic brain injury but compliance with this safety practice is particularly low in urban children. We recruited eleven 8- to 15-year-old youth to participate in focus groups to inform the creation of a video promoting helmet use. Key emerging themes included that youth were responsible for keeping themselves safe and that most youth had cell phones with cases to protect them. A video was created that linked the concept of use of cases to protect phones to use of helmets to protect heads. Soliciting information from urban youth was helpful for developing this educational video.

Association Between Conventional Bicycle Helmet Use and Facial Injuries After Bicycle Crashes

Bicycling is an increasingly common activity in the United States that is often associated with fall injuries to the head and face. Although helmets lessen head injury, their role in reducing facial injuries is less clear; therefore, it is important to understand the protective capacity for the face in current helmet design. To estimate the conventional bicycle helmet's association with the rate of facial injury after bicycle crashes. This retrospective cohort study accessed records from January 1, 2010, to December 31, 2014, from the National Trauma Databank, which collects data from emergency departments in US hospitals. Each record pertained to 1 emergency department admission for a bicycle crash. The National Trauma Databank registry data are collected and recorded by incident, which is equivalent to an injury-related hospital admission. All injuries involving patients aged 18 to 65 years for whom data on helmet use and injury were available were included. Statistical analysis was conducted from July 19 to October 17, 2016. Helmeted and nonhelmeted bicycle crashes. Head and facial injuries among helmeted and nonhelmeted bicycle crashes. A total of 85 187 facial injuries met inclusion criteria (patient age 18-65 years, availability of helmet use status, and type of injury). Demographic information on bicycle riders was frequently unavailable. Among all injuries, fractures to the head (11.6% [9854]) and face (11.3% [9589]) occurred at similar rates. Helmets reduced head fractures by 52% (from 14.0% [7623] to 7.3% [2231]) and head soft-tissue injuries by 30% (from 15.0% [8151] to 10.9% [3358]), but had lower rates in protecting against facial injuries. While reducing facial injuries overall, the amount of protection with helmet use varied with facial location of the injury. Reduction in facial fractures was 35% (95% CI, 31%-39%) for upper face, 28% (95% CI, 23%-32%) for mid face, and 21% (95% CI, 15%-26%) for the lower face. Helmets were less protective against facial soft-tissue injuries, with a reduction of 33% (95% CI, 30%-36%) in the upper face, 21% (95% CI, 16%-26%) in the mid face, and 2% (95% CI, 0%-6%) in the lower face. Although bicycle helmets provide some protection against facial injuries after bicycle crashes, the level of protection depends on the proximity of the injury to the helmeted head. The lower face is particularly vulnerable to injury despite helmet use.

Bicycle helmet use and facial injuries.

Data sourcesPubMed/Medline, Google Scholar and Cochrane Library databasesStudy selectionTwo reviewers independently selected studies. Observational studies involving patients >16 years comparing facial injuries in those wearing and not wearing cycle helmets were included. Studies were excluded if they examined the effects of helmet legislation, reported facial injuries with other injuries, compared different types of helmet or were wholly paediatric studies.Data extraction and synthesisSelection, reporting, attrition and detection bias of studies were assessed. Data were extracted on the incidence of all facial injuries reported in helmet users and non-helmet users by two reviewers independently. Odds ratios (OR) were extracted for facial injuries and facial fractures and meta-analysis conducted.ResultsThis review suggests that bicycle helmets may offer a protective benefit against facial fractures. However, it is noted that previous analyses have shown that this protection is not uniform across the face and that the upper and middle face may be protected.ConclusionsThis review suggests that bicycle helmets may offer a protective benefit against facial fractures. However, it is noted that previous analyses have shown that this protection is not uniform across the face and that the upper and middle face may be protected.

Bicycle helmets and risky behaviour: A systematic review

A long-standing argument against bicycle helmet use is the risk compensation hypothesis, i.e., increased feelings of safety caused by wearing a helmet results in cyclists exhibiting more risky behaviour. However, past studies have found helmet wearing is not associated with risky behaviour, e.g., committing a traffic violation was positively associated with a lower frequency of helmet use. There is a lack of consensus in the research literature regarding bicycle helmet use and the risk compensation hypothesis, although this gap in knowledge was identified in the early 2000s. This is the first study to carry out a systematic review of the literature to assess whether helmet wearing is associated with risky behaviour. Two study authors systematically searched the peer-reviewed literature using five research databases (EMBASE, MEDLINE, COMPENDEX, SCOPUS, and WEB OF SCIENCE) and identified 141 unique articles and four articles from other sources. Twenty-three articles met inclusion criteria and their findings were summarised. Eighteen studies found no supportive evidence helmet use was positively associated with risky behaviour, while three studies provided mixed findings, i.e., results for and against the hypothesis. For many of these studies, bicycle helmet wearing was associated with safer cycling behaviour. Only two studies conducted from the same research lab provided evidence to support the risk compensation hypothesis. In sum, this systematic review found little to no support for the hypothesis bicycle helmet use is associated with engaging in risky behaviour.

Would New Zealand adolescents cycle to school more if allowed to cycle without a helmet?

IntroductionThe effectiveness of bicycle helmet use in preventing head injuries has been well documented. Mandatory helmet-use legislation is present in multiple countries including New Zealand. However, studies examining the correlates of adolescents' perception that they would cycle to school more often if helmet legislation was repealed are scant. This study examined these correlates in a sample of New Zealand adolescents. MethodsAdolescents (n = 774; age: 13–18 years) from all 12 secondary schools in Dunedin, New Zealand, completed an online questionnaire about their cycling to school and cycling in general behaviours and perceptions and opinions about bicycle helmet use as a barrier to cycling to school. Data were examined using multivariate linear regression. ResultsOverall, 22.1% of adolescents stated that would cycle to school more often if helmet use was not mandatory. In the multivariate model, perception of the required helmet use as a barrier to cycling to school was positively associated with the actual distance to school, Māori and other ethnicities, adolescents’ perception that cycling to school is not ‘cool’, boring route to school, and frequent cycling with friends (all p < 0.05). Conversely, required helmet use as a barrier for cycling to school was negatively associated with adolescents’ perception that cycling to school is a good way to get exercise (p < 0.05). ConclusionsOne in five adolescents perceived helmet use to be a barrier to cycling to school. Diverse demographic and interpersonal factors as well as environmental influences were identified as significant correlates. The present findings can be used to design educational interventions to influence adolescents’ attitudes towards the helmet use.

시군구 단위 자전거 헬멧 착용률과 자전거 사고율의 연관성

시군구 단위 자전거 헬멧 착용률과 자전거 사고율의 연관성