Bicycle Helmet Use Research Articles

Racial/ethnic and socioeconomic disparities in the use of helmets in children involved in bicycle accidents

PurposeWhile bicycle helmet use reduces bicycle-related head injury, few children wear them regularly. We aimed to describe racial/ethnic and socioeconomic differences in pediatric helmet use in Los Angeles County (LAC) to help target groups for injury prevention programs. MethodsA retrospective review of all pediatric patients involved in bicycle-related accidents in LAC between 2006 and 2011 was performed. Our primary analysis examined the association between helmet use and age, gender, insurance status, and race/ethnicity. We also evaluated the association between helmet use and the need for emergency surgery, mortality, and length of hospital stay (LOH), after adjusting for injury severity score (ISS), age, insurance status, and race/ethnicity. ResultsOf 1248 patients, 11.3% wore helmets, with decreased use among children 12years and older, minorities, and those without private insurance. Overall, 5.9% required an emergency operation, 34.1% returned to their pre-injury capacity, and mortality was 0.7%. On multivariable analysis, higher ISS increased LOH, the risk for emergency surgery, and mortality. ConclusionNearly 90% of children involved in bicycle-related accidents were not wearing helmets. Helmet use was lower among older children, minorities, and those from a low socioeconomic status. Injury prevention programs targeting low-income middle and high schools and minority communities may help increase helmet use in children in LAC.

Barriers to Bicycle Helmet Use in Young Children in an Urban Elementary School

Traumatic brain injury is a leading cause of death in bicycle crashes. The factors associated with bicycle helmet use in young children with diverse ethnic and socioeconomic backgrounds have not been studied. The purpose of this study was to identify barriers to helmet use in young children in an urban elementary school. Qualitative content analysis with semistructured interviews, observational field notes, and artifacts. Urban elementary school. Seventeen students whose age ranged from 5 to 7 years and whose ethnic background was identified as African American (14) or Caucasian (3). Children participated in a brain safety fair that included presentations and activities. Semistructured, pre- and postexperience interviews were completed. Observations of the students participating in the activities and reflective art projects from the students were collected. The analysis found the following barriers to helmet use: (a) lack of access to a helmet, (b) poor fit of helmets due to hairstyles, and (c) lack of knowledge regarding helmet use. The present study suggests that the issue of helmet design and comfort for younger children with variable hairstyles needs to be addressed in order to increase helmet use in this population.

Parenting Influences on Bicycle Helmet Rules and Estimations of Children's Helmet Use

ABSTRACT The present study examined the potential relationship between parenting variables and estimations of children's bicycle helmet use. Parents (N = 121) completed surveys asking about parental monitoring and questions about their bicycle habits and attitudes, as well as their expectations for their children to wear a helmet and their estimation of how often their children wear a helmet. Parents reported stronger helmet rules for their children who are beginning cyclists rather than experienced cyclists, and rules for experienced cyclists were more strongly endorsed among parents who reported more parental monitoring as well. Parents who wear helmets themselves endorsed stronger helmet rules for their experienced riders, compared to parents who do not wear helmets. Parents without helmet rules reported more peer pressure in that they were more likely to agree that their friends do not make their kids wear helmets and that their child's friends do not wear helmets. In addition, believing other parents do not wear helmets and believing one's child's friends do not wear helmets were both associated with a lower likelihood that their children wear a helmet. This appears to be the first study linking perceptions of parental peer pressure with helmet rules and use. For public health reasons, it is imperative to examine parental factors that may establish children's helmet wearing.

Helmet Use Among Users of the Citi Bike Bicycle-Sharing Program: A Pilot Study in New York City

The use of bicycle helmets to prevent or reduce serious head injuries is well established. However, it is unclear how to effectively promote helmet use, particularly in the context of bicycle-sharing programs. The need to determine rates of helmet use specifically among users of bicycle-sharing programs and understand if certain characteristics, such as time of day, affect helmet use, is imperative if effective promotion and/or legislative efforts addressing helmet use are to be developed. We estimated the prevalence of helmet use among a sample of Citi Bike program users in New York City. A total of 1,054 cyclists were observed over 44 h and across the 22 busiest Citi Bike locations. Overall, 85.3% (95% CI 82.2, 88.4%) of the cyclists observed did not wear a helmet. Rates of helmet non-use were also consistent whether cyclists were entering or leaving the docking station, among cyclists using the Citi Bikes earlier versus later in the day, and among cyclists using the Citi Bikes on weekends versus weekdays. Improved understanding about factors that facilitate and hinder helmet use is needed to help reduce head injury risk among users of bicycle sharing programs.

Canadian Academy of Sport and Exercise Medicine Position Statement

The Canadian Academy of Sport and Exercise Medicine (CASEM) has updated the position statement regarding the support for mandatory use of bicycle helmets. This revises the previous version written in 2002. This statement reflects changes that occurred during the past 10 years. There has been more focus on the adoption of the helmet as a protective device and the means to promote its use including educational and legislative efforts. These recommendations are made with the support of scientific studies and systematic reviews of existing evidence. The policy statement is available at no cost at: http://journals.lww.com/cjsportsmed/Fulltext/2013/11000/Canadian_Academy_of_Sport_and_Exercise_Medicine.2.aspx Language: en

Bicycle helmet use in Canada: The need for legislation to reduce the risk of head injury

Bicycle helmet use in Canada: The need for legislation to reduce the risk of head injury

Factors associated with bicycle-helmet use among 8–16 years aged Turkish children: a questionnaire survey

The purpose of this cross-sectional, descriptive study was to assess the rates of helmet and to examine variables related to bicycle helmet use in a sample of 8–16 year old Turkish children. Data were collected from a purposive sample of 1180 students who self-identified as cyclists and 1128 parents or guardians in two state primary schools in two urban municipalities in the northern part of Istanbul, Turkey. Results showed that self-reported helmet use was found prevalent in 4.4% of the children. The most cited reasons for not wearing a helmet were: ‘don't own one’, ‘helmets are uncool’, and ‘uncomfortable’. Significant differences between helmet users and non-users correlated to gender, age, owning a bicycle helmet, wearing a friend's bicycle helmet and parents or guardian's bicycle helmet use while riding. Only three variables – helmet ownership (OR = 10.028, 95% CI 5.08, 19.79), parents’ helmet use (OR = 2.62, 95% CI 1.22, 5.66) and friends’ helmet use (OR = 0.16, 95% CI 0.07, 0.37) emerged as significant predictors of the likelihood of helmet use. The relatively low helmet use prevalence points to an urgent need for a multipronged campaign, including strategies such as raising awareness, educating primarly parents and friends, and distributing bicycle helmets for free or at a reduced cost.

A Descriptive Study of Bicycle Helmet Use in Montreal, 2011

The purpose of this study was to describe bicycle helmet use among Montreal cyclists as a step towards injury prevention programming. Using a cross-sectional study design, cyclists were observed during 60-minute periods at 22 locations on the island of Montreal. There were 1-3 observation periods per location. Observations took place between August 16 and October 31, 2011. Standard statistical methods were used, unadjusted and adjusted odds ratios and 95% confidence interval were calculated. A total of 4,789 cyclists were observed. The helmet-wearing proportion of all cyclists observed was 46% (95% CI 44-47). Women had a higher helmet-wearing proportion than men (50%, 95% CI 47-52 vs. 44%, 95% CI 42-45, respectively). Youth had the highest helmet-wearing proportion (73%, 95% CI 64-81), while young adults had the lowest (34%, 95% CI 30-37). Visible minorities were observed wearing a helmet 29% (95% CI 25-34) of the time compared to Caucasians, 47% (95% CI 46-49). BIXI (bike sharing program) riders were observed wearing a helmet 12% (95% CI 10-15) of the time compared to riders with their own bike, 51% (95% CI 49-52). Although above the national average, bicycle helmet use in Montreal is still considerably low given that the majority of cyclists do not wear a helmet. Injury Prevention Programs could target the entire cyclist population, but special attention may be warranted in specific groups such as young men, visible minorities, BIXI riders, and those riding in tourist areas. Additionally, a collaborative enterprise with the bicycle sharing system BIXI Montreal™ could prove to be fruitful in addressing the availability of bike helmets for BIXI riders.

Evolution of bicycle helmet use and its determinants in France: 2000–2010

This paper aims to analyse helmet use in France, as a voluntary behaviour rather than a legal requirement, promoted by public awareness campaigns. It aims to investigate the determinants of helmet wearing and to explore its evolution from 2000 to 2010. The analysis relies on data from a series of general population surveys called “Health Barometers”: 2000 (n=13,163), 2005 (n=25,651) and 2010 (n=8573). Multivariate logistic regressions were used to identify factors associated with helmet use and time trends. Nearly half of the 15–75 year olds surveyed reported that they rode a bicycle, and among these cyclists, 22.0% reported that they wore a helmet on their last ride. Further analysis by gender reveals that twice as many men than women wore helmets. Over the last decade, helmet use among cyclists has clearly increased, from 7.3% in 2000 to 22.0% in 2010, whereas the influence of social and economic factors, such as unemployment and wage disparities, appears to have decreased. Several determinants of bicycle helmet use were highlighted. To improve the effectiveness of further public information campaigns on helmet use, the key target groups should include women, under 25 year olds and people living in urban areas. Promoting the wearing of helmets among families should also be enhanced, given the higher rate of helmet use by parents as well as children.

Poverty is the problem, not colour

Journal of Paediatrics and Child HealthVolume 49, Issue 6 p. 504-504 Heads UpFree Access Poverty is the problem, not colour First published: 03 June 2013 https://doi.org/10.1111/jpc.12229_4Citations: 1AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat A US computer-assisted interview survey of 10- and 11-year-old children in Alabama, Houston and Los Angeles state schools and their parents evaluated 16 health-related measures.1 These were witnessing physical assault without a weapon, witnessing threat or injury with a gun, victimisation by peers, perpetration of non-physical aggression, perpetration of physical aggression, cigarette smoking, alcohol use, seat-belt use, bike-helmet use, experience of discrimination, worrying about terrorism, obesity, vigorous exercise, health status, psychological quality of life and physical quality of life. There were significant differences in all 16 health-related measures between black children and white children and significant differences in 12 of 16 measures between Latino children and white children. However, there were also significant differences in socioeconomic factors including income and education, and most health disparities disappeared or were reduced when socioeconomic factors were taken into account. Reference 1 Schuster MA et al. N. Engl. J. Med. 2012; 367: 735– 745. Reviewer: David Isaacs, david.isaacs@health.nsw.gov.au Citing Literature Volume49, Issue6June 2013Pages 504-504 ReferencesRelatedInformation

Consistency in preferences for road safety: An analysis of precautionary and stated behavior

This study analyzes stated willingness to pay (WTP) for traffic safety, the use of traffic safety equipments, and the consistency between the two. Using data from a Swedish contingent valuation study we find that the estimated value of a statistical life (VSL) based on the respondents' rear-seatbelt usage is similar to the estimate found using the respondents' stated WTP. However, when estimating VSL based on the respondents' use of bicycle helmets we find a significantly higher VSL; the VSL from bicycle-helmet usage is 7 times higher than the estimate based on seatbelt usage. Moreover, we do not find any strong relationship between risk perception and usage, or individual stated WTP and usage. Hence, the main conclusion, based on our analysis, is that stated and observed WTP are not consistent.

Bicycle helmet use and bicycling-related injury among young Canadians: an equity analysis.

IntroductionCycling is a major activity for adolescents in Canada and potential differences exist in bicycling-related risk and experience of injury by population subgroup. The overall aim of this study was to inform health equity interventions by profiling stratified analytic methods and identifying potential inequities associated with bicycle-related injury and the use of bicycle helmets among Canadian youth. The two objectives of this study were: (1) To examine national patterns in bicycle ridership and also bicycle helmet use among Canadian youth in a stratified analysis by potentially vulnerable population subgroups, and (2) To examine bicycling-related injury in the same population subgroups of Canadian youth in order to identify possible health inequities.MethodsData for this study were obtained from the 6th cycle (2009/10) of the Health Behaviour in School-aged Children (HBSC) study, which is a general health survey that was completed by 26,078 students in grades 6–10 from 436 Canadian schools. Based on survey responses, we determined point prevalence for bicycle ridership, bicycle helmet use and relative risks for bicycling-related injury.ResultsThree quarters of all respondents were bicycle riders (n=19,410). Independent factors associated with bicycle ridership among students include being male, being a younger student, being more affluent, and being a resident of a small town. Among bicycle riders, 43% (95%CI ± 0.6%) reported never wearing and 32% (± 0.6%) inconsistently wearing a helmet. Only 26% (± 0.5%) of students reported always wearing a bicycle helmet. Helmets were less frequently used among older students and there were also important patterns by sex, geographic location and socioeconomic status. Adjusting for all other demographic characteristics, boys reported 2.02-fold increase (95% CI: 1.61 to 1.90) and new immigrants a 1.35-fold increase (95%CI: 1.00 to1.82) in the relative risk of bicycling-related injury in the past 12 months, as compared to girls and students born in Canada. The relative risk of injury did not vary significantly by levels of socioeconomic status.ConclusionsTroubling disparities exist in bicycle use, bicycle helmet use and bicycling-related injuries across specific population subgroups. Bicycle safety and injury prevention initiatives should be informed by disaggregated analyses and the context of bicycle-related health differences should be further examined.

Clinical and legal issues associated with the use of cycle helmets

PurposeThis paper aims to be a review of the clinical and legal issues surrounding the wearing of cycle helmets. It explains how helmets work, the standards currently in place and arguments for and against their protective value. It then considers how this clinical and actuarial data has been interpreted in case law and in particular the issue of contributory negligence.Design/methodology/approachA search of scientific databases and public search engines was used to review the relevant literature up to August 2012.FindingsThere is conflicting evidence for the protective value of cycle helmets. Some researchers have found helmets to protect against head and facial injuries. Others have criticised the research methods used and questioned whether helmets can protect the wearer from the most damaging types of head injury. No trial judge has yet found a case for contributory negligence on the part of a cyclist not wearing a helmet.Research limitations/implicationsResearch cannot use randomised control trials and is limited to other methodologies. Further work should focus on a range of aspects of safer cycling including cyclist and driver safety awareness along with comparing the safety factors of existing designs and developing better helmet design. Cyclists may wish to consider wearing a helmet to avoid claims for contributory negligence in the future.Originality/valueThis paper combines both the clinical and legal debate surrounding cycle helmet use. The paper will better inform clinicians, members of the legal profession, members of Government responsible for introducing legislation, helmet designers/manufacturers and individuals wishing to make an informed decision about helmet use.

Prevention of Traumatic Brain Injury in Youth and Adolescents

The goal of this project was to promote bicycle helmet use via an inpatient educational program. We hypothesized that this program would increase bicycle helmet use. One hundred twenty inpatients with history of regular (>1 time per week) bicycle riding (mean age 10.0 ± 3.6 years; 67 males, 53 females; 57 whites, 59 blacks, 4 other) were randomized to treatment (n = 58) or control (n = 62) groups. All participants received a bicycle helmet. At 1 month, 50 (92.6%) of the intervention group and 48 (82.8%) of the control group wore a helmet every bike ride (P < .07). At 3 months, 50 (96.2%) of the intervention group and 44 (80%) of the controls wore a helmet with every bike ride (P < .03). The study proved feasible, requiring trained personnel to deliver the intervention. Providing a helmet without the intervention was effective in 80% to 83% of cases with respect to parental report of helmet wearing compliance.

Bicycle helmet use should help prevent serious head injury in children

Bicycle helmet use should help prevent serious head injury in children

Performance analysis of the protective effects of bicycle helmets during impact and crush tests in pediatric skull models

Bicycle accidents are a very important cause of clinically important traumatic brain injury (TBI) in children. One factor that has been shown to mitigate the severity of lesions associated with TBI in such scenarios is the proper use of a helmet. The object of this study was to test and evaluate the protection afforded by a children's bicycle helmet to human cadaver skulls with a child's anthropometry in both "impact" and "crushing" situations. The authors tested human skulls with and without bicycle helmets in drop tests in a monorail-guided free-fall impact apparatus from heights of 6 to 48 in onto a flat steel anvil. Unhelmeted skulls were dropped at 6 in, with progressive height increases until failure (fracture). The maximum resultant acceleration rates experienced by helmeted and unhelmeted skulls on impact were recorded by an accelerometer attached to the skulls. In addition, compressive forces were applied to both helmeted and unhelmeted skulls in progressive amounts. The tolerance in each circumstance was recorded and compared between the two groups. Helmets conferred up to an 87% reduction in so-called mean maximum resultant acceleration over unhelmeted skulls. In compression testing, helmeted skulls were unable to be crushed in the compression fixture up to 470 pound-force (approximately 230 kgf), whereas both skull and helmet alone failed in testing. Children's bicycle helmets provide measurable protection in terms of attenuating the acceleration experienced by a skull on the introduction of an impact force. Moreover, such helmets have the durability to mitigate the effects of a more rare but catastrophic direct compressive force. Therefore, the use of bicycle helmets is an important preventive tool to reduce the incidence of severe associated TBI in children as well as to minimize the morbidity of its neurological consequences.

A population-based study of direct health care costs for treatment of Paediatric concussions

BackgroundPaediatric concussions are an important reason for children to seek care from their physician or in the Emergency Department. Although there are strategies that can help prevent concussions, including environmental...

Racial and Ethnic Health Disparities among Fifth-Graders in Three Cities

BackgroundFor many health-related behaviors and outcomes, racial and ethnic disparities among adolescents are well documented, but less is known about health-related disparities during preadolescence.MethodsWe studied 5119 randomly selected public-school fifth-graders and their parents in three metropolitan areas in the United States. We examined differences among black, Latino, and white children on 16 measures, including witnessing of violence, peer victimization, perpetration of aggression, seat-belt use, bike-helmet use, substance use, discrimination, terrorism worries, vigorous exercise, obesity, and self-rated health status and psychological and physical quality of life. We tested potential mediators of racial and ethnic disparities (i.e., sociodemographic characteristics and the child's school) using partially adjusted models.ResultsThere were significant differences between black children and white children for all 16 measures and between Latino children and white children for 12 of 16 measures, although adjusted analyses reduced many of these disparities. For example, in unadjusted analysis, the rate of witnessing a threat or injury with a gun was higher among blacks (20%) and Latinos (11%) than among whites (5%), and the number of days per week on which the student performed vigorous exercise was lower among blacks (3.56 days) and Latinos (3.77 days) than among whites (4.33 days) (P<0.001 for all comparisons). After statistical adjustment, these differences were reduced by about half between blacks and whites and were eliminated between Latinos and whites. Household income, household highest education level, and the child's school were the most substantial mediators of racial and ethnic disparities.ConclusionsWe found that harmful health behaviors, experiences, and outcomes were more common among black children and Latino children than among white children. Adjustment for socioeconomic status and the child's school substantially reduced most of these differences. Interventions that address potentially detrimental consequences of low socioeconomic status and adverse school environments may help reduce racial and ethnic differences in child health. (Funded by the Centers for Disease Control and Prevention.)

Prevalence of Bicycle Helmet Use by Users of Public Bikeshare Programs

Public bikeshare programs are becoming increasingly common in the United States and around the world. These programs make bicycles accessible for hourly rental to the general public. We seek to describe the prevalence of helmet use among adult users of bikeshare programs and users of personal bicycles in 2 cities with recently introduced bikeshare programs (Boston, MA, and Washington, DC). We performed a prospective observational study of adult bicyclists in Boston, MA, and Washington, DC. Trained observers collected data during various times of the day and days of the week. Observers recorded the sex of the bicycle operator, type of bicycle, and helmet use. All bicycles that passed a single stationary location in any direction for a period of between 30 and 90 minutes were recorded. There were 43 observation periods in 2 cities at 36 locations; 3,073 bicyclists were observed. There were 562 (18.3%; 95% confidence interval [CI] 16.4% to 20.3%) bicyclists riding shared bicycles. Overall, 54.5% of riders were unhelmeted (95% CI 52.7% to 56.3%), although helmet use varied significantly with sex, day of use, and type of bicycle. Bikeshare users were unhelmeted at a higher rate compared with users of personal bicycles (80.8% versus 48.6%; 95% CI 77.3% to 83.8% versus 46.7% to 50.6%). Logistic regression, controlling for type of bicycle, sex, day of week, and city, demonstrated that bikeshare users had higher odds of riding unhelmeted (odds ratio [OR] 4.4; 95% CI 3.5 to 5.5). Men had higher odds of riding unhelmeted (OR 1.6; 95% CI 1.4 to 1.9), as did weekend riders (OR 1.3; 95% CI 1.1 to 1.6). Use of bicycle helmets by users of public bikeshare programs is low. As these programs become more popular and prevalent, efforts to increase helmet use among users should increase.

Emotional reactions to cycle helmet use

It has been suggested that the safety benefits of bicycle helmets are limited by risk compensation. The current article tests if previous helmet use influences the response to helmets as a safety intervention. This was investigated in a field experiment where pace and psychophysiological load were measured. We found that after having removed their helmets, routine helmet users cycled more slowly and demonstrated increased psychophysiological load. However, for non-users there was no significant change in either cycling behaviour or psychophysiological load. We discuss the implications of these results for a hypothesis of risk compensation in response to helmet use. We also show that heart rate variability is a promising measure of psychophysiological load in real-world cycling, at least in situations where there is limited physical demand.