Helmet Ownership Research Articles

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...

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.

Teenage attitudes to bicycle helmets

Reports a study investigating teenage attitudes towards bicycle helmets. A questionnaire was administered to a sample of 1,093 11‐16‐year‐olds to assess their helmet ownership and use and their attitudes towards bicycle helmets. More 11‐13‐year‐olds owned cycle helmets than 14‐16‐year‐olds, with similar wearing rates across age. Girls placed more importance on whether helmet wearing was compulsory at school and comfort of helmets, while boys placed more importance on whether helmet wearing was compulsory by law. Those who owned helmets were more likely to place importance on whether wearing a helmet was law and whether it was a school rule than were those who did not own helmets. The 11‐13‐year‐olds placed more importance on whether helmet wearing was compulsory at school and by law, while 14‐16‐year‐olds placed more importance on comfort, appearance, cost, and their friends’ opinions as reasons.

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.

Prevalence of cycle helmet use in children

A survey was conducted over a five-day period on a cohort of 234 families attending a busy regional children's out-patient department in the South West of England. A significant result of the survey was that parental use of helmets strongly correlated with the use of helmets by children. In addition, income was not found to be a major factor in cycle helmet ownership except in the lowest income band.

Impact of a theory based intervention to increase bicycle helmet use in low income children

Objective—While community interventions to increase bicycle helmet use have increased markedly, few of these studies are theoretically based. The purpose of this study was to determine relationships among PRECEDE model...

Cycle helmet ownership and wearing; results of a survey in South Staffordshire.

Despite increasing evidence indicating that wearing cycle helmets can reduce the severity of head injuries, particularly in children, there is a paucity of local data on cycle helmet ownership and wearing rates. These data together with an understanding of the factors which influence these rates are important in developing appropriate health promotion programmes. The objectives were to (1) establish patterns of cycle helmet ownership and wearing rates, and (2) determine factors influencing these rates. A descriptive survey involving a self-completed questionnaire was undertaken and a series of focus groups were also established. The setting was two high schools and four primary schools in each of the six boroughs or district councils within South Staffordshire involving 932 Year 6 and 2005 Year 10 children. The response ratio was 70.9 per cent from Year 6 and 80.9 per cent from Year 10, giving an overall response rate of 77.8 per cent. Most children (86.6 per cent) rode a bicycle and of these 42.8 per cent owned a cycle helmet. Just over a third (36.8 per cent) of Year 6 cyclists wore a helmet always or nearly always, compared with 13.7 per cent of Year 10 cyclists. Although the protective effect of cycle helmets was appreciated, many children did not see themselves as being personally at risk, particularly on short journeys. The appearance and comfort of the helmet appeared to be stronger factors influencing the uptake of helmets compared with cost. Both year groups were similarly concerned with comfort, but Year 10 children appeared more concerned with appearance than Year 6 children. Cycle helmet ownership and wearing is still disappointingly low, especially amongst older children. The factors influencing patterns of ownership and wearing are numerous and the interrelationships between them are complex, requiring a co-ordinated approach from a range of agencies. Cycle helmet legislation should be considered by the Government.

Evaluation of a four-year bicycle helmet promotion campaign in Quebec aimed at children ages 8 to 12: impact on attitudes, norms and behaviours.

This study evaluated a four-year bicycle helmet promotion campaign. Children's attitudes, social norms, intentions to wear a bicycle helmet as well as helmet ownership were measured. Evaluation was based on a pre-experimental static group comparison design repeated at two (1991) and four years (1993) after implantation, with a non-randomized control group. 3,424 students completed a self-administered questionnaire (experimental: 2,097, control: 1,327). The program had a significant impact on helmet ownership (1989: 4%; 1991: 26%; 1993: 56%). The program was the principal predictor of high intention to use a bicycle helmet. Time was the principal predictor of ownership with exposure to the program being the next predictor. This study showed that time is an important factor in bicycle helmet acquisition, and that a long-term community-based program can accelerate the process of adopting this behaviour.

Evaluation of a Four-year Bicycle Helmet Promotion Campaign in Quebec Aimed at Children Ages 8 to 12: Impact on Attitudes, Norms and Behaviours

This study evaluated a four-year bicycle helmet promotion campaign.Children's attitudes, social norms, intentions to wear a bicycle helmet as well as helmet ownership were measured. Evaluation was based on a pre-experimental static group comparison design repeated at two (1991) and four years (1993) after implantation, with a non-randomized control group. 3,424 students completed a self-administered questionnaire (experimental: 2,097, control: 1,327).The program had a significant impact on helmet ownership (1989: 4%; 1991: 26%; 1993: 56%). The program was the principal predictor of high intention to use a bicycle helmet. Time was the principal predictor of ownership with exposure to the program being the next predictor.This study showed that time is an important factor in bicycle helmet acquisition, and that a long-term community-based program can accelerate the process of adopting this behaviour.

Children's bicycle helmet attitudes and use. Association with parental rules. The Pediatric Practice Research Group.

Previous studies have assessed the attitudes of parents and children toward bicycle helmet ownership and use in various settings, but they have not addressed the role of parental rules in promoting bicycle helmet use by children. To further explore the attitudes of parents and children at pediatric practices toward bicycle helmet ownership and use by children and to assess the role of parental rules in promoting bicycle helmet use by children. One hundred sixty-nine 5- to 14-year-old children who owned bicycles and their parents were surveyed during well-child visits at 5 general pediatric practices in the Chicago, Ill, area. One hundred twenty-nine families were represented. Of the children, 60% were aged 5 to 9 years, and 50% were girls. Forty-eight children (28%) reported helmet ownership. Of the helmet owners, 21 (45%) reported helmet use; thus, the overall percentage of helmet use was 12%. Helmet ownership by children was significantly (P < .05) related to parental characteristics: educational level, race, perceived effectiveness of bicycle helmets, seat belt use, and parental helmet ownership. The most common reasons parents gave for lack of helmet ownership by children were "never thought about purchasing" a helmet (35%), "never got around to purchasing" a helmet (29%), "child wouldn't wear it anyway" (26%), and the bicycle helmet was "too expensive" (16%). Only 33% of the parents reported hearing about helmets from their children's pediatrician, but 40% of these parents regarded pediatricians as their most important information source. Of the children who did not own helmets, 64% said they would wear a bicycle helmet if they had one, a more frequent comment for 5- to 9-year-old children than 10- to 14-year-old children (76% vs 49%, P < .01). The most common reasons for not wearing a helmet among owners were as follows: forgot or lost it and not needed. The most common reasons for not wearing a helmet among nonowners were as follows: uncomfortable and appearance or perception of others. Children who owned helmets and whose parents had a strict rule about wearing helmets were more likely to always wear their helmets than helmet owners whose parents had a partial rule or no rule (88% vs 19%, P < .001). Parental rules are associated with bicycle helmet use by children. Pediatricians may increase helmet use rates by promoting strict parental helmet rules as part of their anticipatory guidance regarding bicycle safety. More research about the effectiveness of this strategy is needed.

Bicycle helmet use among American children, 1994.

To estimate ownership and use of bicycle helmets among children in the US in 1994. As part of a 1994 national telephone survey of 5,238 randomly dialed households, adult respondents reported data on bicycle helmet ownership and helmet use among 1,645 child bicyclists. Data were weighted to provide national estimates. It is estimated that 72.7% of children 5-14 year olds ride bicycles, that is, 27.7 million child bicyclists. Of the bicyclists, 50.2% have a helmet and 25.0% reportedly always wore their helmet when cycling. Reported helmet ownership and use increased with income and educational level and decreased with age. Among regions of the US, those with the highest proportion of states with helmet use laws in 1994 also had the highest proportion of helmet use among children. Among child bicyclists who had been seen by a health care provider in the preceding 12 months, 43.9% of those counseled to wear a bicycle helmet were reported to comply compared with 19.1% of those seen by a provider but not so counseled (p < 0.001). To meet the year 2000 objective of 50% of bicyclists wearing helmets, use among American children will have to double. Concerted and increased efforts to promote the wearing of bicycle helmets are necessary.

Evaluation of a Subsidy Program to Increase Bicycle Helmet Use by Children of Low-Income Families

We have previously shown that an educational program was not effective in increasing bicycle helmet use in children of low-income families. The objective of this study was to evaluate a combined educational and helmet subsidy program in the same population, while controlling for secular trends. The secondary objective was to complete a third year of surveying children's bicycle helmet use throughout the study community. A prospective, controlled, before-and-after study. Bicycling children 5 to 14 years of age from areas of low average family income. A defined geographic community within a large urban Canadian city. In April 1992, students in three schools located in the area of lowest average family income were offered $10 helmets and an educational program; three other low-income areas served as control areas. Helmet use was determined by direct observation of more than 1800 bicycling children. Nine hundred ten helmets were sold to a school population of 1415 (64%). Reported helmet ownership increased from 10% to 47%. However, observed helmet use in the low-income intervention area was no different from the rate in the three low-income control areas (18% versus 19%). There was no difference in the trend in helmet use during the period of 1990 through 1992 in the intervention area (4% to 18%) compared with the control areas (3% to 19%). Helmet use rates from all income areas have increased from 3.4% in 1990, to 16% in 1991, to 28% in 1992. In 1992, helmet use in the high-income areas was 48% and in the low-income areas was 20%. There has been a trend toward increasing helmet use in all income areas during the 3-year period. Despite encouraging helmet sales and increases in reported helmet ownership, the results of the observational study do not support the efficacy of a helmet subsidy program in increasing helmet use in children residing in areas of low average family income. Strategies to increase helmet use in children of low average family income remain a priority.

Helmets and Horseback Riders

To determine patterns of helmet use and attitudes toward helmets among horseback riders, we analyzed a subset of data (n = 1,834) from a cross-sectional mail survey of horseback riders conducted from July to December 1991. Riders were randomly selected from the mailing list of a national mail-order company that sells horseback-riding equipment. Of 900 English-style riders, 517 (57.5%) wore helmets on their last ride, compared with only 81 of 684 (11.8%) Western-style riders. Among 546 riders who did not own helmets, their most commonly cited reasons included believing that helmets were unnecessary (43.8%) or uncomfortable (29.9%). Of the 1,263 helmet owners, nearly 62% had one or more complaints about helmets, but 41.1% of owners reported that their helmet had prevented at least one head injury. Increasing helmet use will require major educational efforts with horseback riders and design changes by manufacturers.

A proposal for the mandatory inclusion of helmets with new children's bicycles.

To reduce bicycle-related head injuries in children, we propose new regulations be established that mandate the inclusion of approved helmets with the sale of all new children's bicycles. Currently, purchasing a helmet is a separate economic decision that acts as a barrier to helmet ownership and use. The inclusion of a helmet with the bicycle would markedly increase helmet ownership. The increased demand would reduce the manufacturing cost per helmet, so the cost of the bicycle with the helmet would be lower than the current retail price of the two separately. This proposal could potentially be implemented by federal or state legislation, a Consumer Product Safety Commission regulation, or voluntary adoption of a practice or standard by bicycle manufacturers. Increased helmet ownership is necessary but not sufficient to raise helmet use rates. The increased ownership generated by this proposal, complemented by enhanced educational, promotional, and legal interventions, is probably the most practical and cost-effective public health strategy available to increase helmet usage and prevent bicycle-related head injuries in children.

Evaluation of a community bicycle helmet promotion campaign: what works and why.

This study identifies effective components of a bicycle helmet promotion campaign, and mechanisms by which these components affect child helmet ownership. A random telephone survey identified parents whose children did not own helmets prior to an educational campaign. A follow-up survey was conducted six months later. Regression analysis estimated the effects of four campaign components on child helmet ownership and tested for mediation by cognitive variables. Study participants were residents of a suburban community which undertook a citywide educational campaign to increase child helmet ownership. Subjects were 210 parents with at least one school-aged child, none of whom owned helmets. A multicomponent campaign was implemented by a community coalition. In addition, random subsamples of the study participants received direct mail or direct telephone communications. Of the eligible respondents identified in the baseline sample, 39% completed the follow-up survey. Regression analysis showed that children whose parents received either helmet advice from a physician or direct telephone communications were 2.6 and 2.2 times more likely, respectively, to own helmets as children whose parents did not experience similar communication. Parental worry mediated the association, but parental beliefs about the effectiveness of helmets did not. Future helmet campaigns should use interpersonal strategies to increase parental worry about their children being involved in a bicycle accident. Generalization of these findings is limited by the high socioeconomic status of the study participants, and by the outcome measure, which is helmet ownership, not helmet use.

Correlates of Children's Bicycle Helmet Use and Short-term Failure of School-level Interventions

To test the utility of school-level interventions for child bicycle safety and to identify social and behavioral factors associated with children's bicycle helmet use, a two-level intervention was conducted in two suburban elementary schools. Children (N = 209) and parents (N = 125) in school 1 and in school 2 (children, N = 470; parents, N = 364) were surveyed regarding bicycle injuries and helmet use. Children and parents in schools 1 and 2 received literature about bicycle safety and discount coupons for helmet purchase. School 1 was then the target of an intensive safety campaign, including meetings with the school safety committee and the PTA and a classroom presentation to children emphasizing helmet use. Ten months later the same survey was again administered. Children in school 1 were more likely at posttest to believe that helmets were protective (P = .003) but did not differ on other variables. Logistic regression showed that sibling helmet ownership, parental helmet use, and lower parental perceived social barriers to helmet use were independently associated with children's reported helmet use and with parental intent for the child to use a helmet at posttest.

Moving Targets: Bicycle-Related Injuries and Helmet Use among University Students

We conducted a cross-sectional study to evaluate bicycling habits and helmet use in a sample of university students in a southwestern state university. Thirty-one of 100 students in our sample owned bicycle helmets; of these, 17 (54.8%) wore helmets during most (more than three fourths) of their bicycle trips. Almost half of the students reported that more than 25% of their bicycling was done in heavy traffic but they rarely used bicycle trails. Sixty-five students in the sample had sustained at least one minor injury during the previous 5 years, and 18 had been hospitalized as a result of bicycle-related injuries. We found no substantial differences between male and female subjects in bicycle-related hospitalizations, although male subjects were more likely to sustain minor injuries than were females. Helmet ownership was most strongly associated with previous injury experience, especially hospitalization resulting from bicycling injuries (OR = 3.6; 95% CI = 1.3, 10.1). We also observed an association between helmet ownership and possession of insurance coverage for bicycling injuries (OR = 3.0; 95% CI = 1.2, 7.6). Ethnicity was a factor in helmet ownership--helmets were owned by 26 of 69 (37.7%) of non-Hispanic whites, in contrast to 1 of 24 (4.2%) of all other ethnic groups combined. Our survey data suggest that perceived risk is an important factor in bicyclists' use of safety helmets.

Attitudes Toward Bicycle Helmet Ownership and Use by School-age Children

To identify attitudes toward bicycle helmet ownership and use, questionnaires were sent to parents of 2178 third-graders; 1057 (48.5%) returned valid responses. Of 931 children who had bicycles, 24% owned helmets, but only 56% of children who owned helmets wore them. Helmet ownership, but not use, was associated with higher parental education. Fifty-one percent of 704 parents of bicycle owners who had not purchased helmets said they had never thought of it, 29% thought helmets were too costly, and 20% felt their children would not wear them. Of 792 children who did not wear helmets, 25% said they did not wear them because their friends did not; 22% never thought about wearing helmets; and 16% found them uncomfortable. Efforts to increase the wearing of helmets should address helmet design, awareness, peer pressure, and cost.

Barriers to bicycle helmet use among children. Results of focus groups with fourth, fifth, and sixth graders.

As a preliminary step in the development of a school-based educational intervention to promote bicycle helmet use among children, focus group encounters were conducted with fourth, fifth, and sixth graders at three elementary schools in the Boston, Mass, area. Analysis of transcripts of encounter tape recordings indicated that (1) the prevalence of helmet ownership and use was low, (2) children were concerned that helmet use would invite derision from their peers, and (3) children tended to respect other children who wore helmets. We concluded that focus groups can be useful in conceptualizing health education interventions and suggest that school-based peer-led bicycle helmet programs may be effective in developing normative change toward helmet use among elementary schoolchildren.

Pediatric Neuromuscular Diseases

<b>Aims:</b> 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. <b>Methods:</b> Cross sectional survey in 28 primary schools in deprived areas of Nottingham; 1061 year 5 schoolchildren were studied. <b>Results:</b> All year 5 children attending school on the day of the survey completed the questionnaire (87% of children registered at participating schools). Children residing in a deprived area were less likely to own a bike and more likely to ride it four days a week or more. Half the children owned a helmet (52%), but only 29% of these always wore their helmet. Children in deprived areas were less likely to own a helmet, but those that owned a helmet were not less likely to always wear one. Family encouragement and parental warning of dangers of not wearing a helmet were associated with increased helmet ownership rates. Family encouragement and best friends wearing a helmet were associated with higher rates of helmet wearing. <b>Conclusions:</b> Programmes aimed at preventing head injury among child cyclists will need to address the inequality in helmet ownership that exists between children residing in deprived and non-deprived areas. Strategies to increase family encouragement to wear a helmet may be useful, as may those recognising the importance of the attitudes and behaviours of peers, such as peer education programmes. Further work is required to assess how exposure to risk of cycling injury varies with deprivation.