Bicycle Helmet Promotion Programs -- Canada, Australia, and United States
The use of bicycle helmets substantially reduces the risk for
serious head injuries during bicycle-related crashes. Despite this
benefit, epidemiologic data indicate a worldwide low prevalence of
helmet use (1). Strategies to increase the use of bicycle helmets
in
the United States and other countries include subsidies,
legislation,
and education. This report summarizes information regarding three
strategies to increase bicycle helmet use and the impact of
implementing these approaches in Canada (helmet subsidies),
Australia
(legislation), and the United States (education).
Canada. To assess whether the provision of bicycle helmets at
reduced cost increases the use of helmets, the Division of General
Pediatrics, Hospital for Sick Children, in Toronto conducted a
randomized, controlled study in Toronto from May through September
1992 (2). Students in three elementary schools in low-income areas
were offered bicycle helmets for $10 U.S. These students were
compared with students in similar low-income areas who were not
offered subsidized helmets. Reported helmet ownership increased
from
10% to 47% among students in the schools where subsidized helmets
were offered, and reported helmet use increased from 6% to 34%.
However, there were no statistically significant differences in
rates
of observed helmet use between these areas (3% before to 18% after
the study) and the areas where no subsidy was offered (1%-21%).
Australia. In July 1990, the state of Victoria enacted laws
that
made bicycle helmet use compulsory. Specifically, these laws
required
that all persons cycling on roads, footpaths, or separate bicycle
paths, and in public parks wear a securely fitted, approved bicycle
helmet. During the 10 years preceding enactment of these laws, the
state conducted promotional activities to increase helmet use,
including educational campaigns, rebate programs, and publicity
campaigns on radio and television. Direct observation surveys
indicated the prevalence of helmet use among persons aged 5-11
years
in Victoria increased from 26% before enactment of the law to 80%
following enactment (3).
United States. During 1986, the Children's Bicycle Helmet
Coalition in Seattle implemented a community-based education
program
to reduce bicycle-related head injuries among children by promoting
the use of helmets (4). Components of this program included public
and physician education, school safety programs, an outreach
campaign
for low-income populations, extensive media coverage, and
informational brochures in monthly insurance and utility bills. An
evaluation of the impact of this program indicated that, from 1986
through 1992, helmet use among 5-15-year-old children increased
from
5% to 38% (4). In addition, the number of children in this age
group
treated for bicycle-related head injuries at the regional trauma
center in Seattle decreased 50% from 1990 through 1992.
Reported by: P Parkin, MD, L Spence, X Hu, K Kranz, D Wesson, MD,
Hospital for Sick Children, L Shortt, East York Health Unit,
Toronto.
F Nassau, A Anderson, P Leicester, VIC Roads, Victoria, Australia.
A Young, FP Rivara, MD, DC Thompson, RS Thompson, MD, Harborview
Injury Prevention Center, Seattle. Office of the Director, National
Center for Injury Prevention and Control, CDC.
Editorial Note
Editorial Note: Among the 96 million cyclists in the United States
(5), approximately 950 fatalities and 580,000 emergency department
visits occur annually as a result of bicycle injuries (6).
Approximately 62% of these deaths and 32% of the injuries involve
head trauma (6). Helmets are effective in reducing head injuries:
the
estimated risk for head injuries among persons not using helmets is
3.9-6.7 times greater than that among persons using helmets (7).
However, fewer than 2% of U.S. children and fewer than 10% of all
U.S. bicyclists wear helmets (8).
The Injury Prevention Program of the World Health Organization
is coordinating a worldwide initiative to increase the use of
motorcycle and bicycle helmets (9). The initiative focuses on three
approaches: developing and testing helmets, promoting helmet use,
and
evaluating helmet-use promotion strategies. During the Second World
Conference on Injury Control, to be held May 20-23 in Atlanta,
scientists and public health professionals will focus on promoting
and evaluating helmet use.
References
Weiss BD. Bicycle helmet use by children. Pediatrics
1986;77:677-
Parkin P, Spence L, Hu X, Kranz K, Shortt L, Wesson D.
Evaluation
of a subsidy program to increase helmet use in children of
low-income
families. In: Program and abstracts of the Second World Conference
on Injury Control. Atlanta: May 20-23, 1993 (in press).
Nassau F, Anderson A, Leicester P. The introduction of
compulsory
bicycle helmet wearing and the effect of this regulation on
cyclists
in Victoria. In: Program and abstracts of the Second World
Conference
on Injury Control. Atlanta: May 20-23,1993 (in press).
Young A. Bicycle helmets: from research to community program
implementation and evaluation. In: Program and abstracts of the
Second World Conference on Injury Control. Atlanta: May 20-23, 1993
(in press).
Bicycle Institute of America. Bicycling reference book,
1992-1993.
Washington, DC: Bicycle Institute of America, 1992.
Sacks JJ, Holmgreen P, Smith SM, Sosin DM. Bicycle-associated
head
injuries and deaths in the United States from 1984 through 1988.
JAMA
1991;266:3016-9.
Thompson RS, Rivara FP, Thompson DC. A case-control study of the
effectiveness of bicycle safety helmets. N Engl J Med
1989;320:1361-
Anonymous. Bike helmets: unused lifesavers. Consumer Reports
1990;55:348-53.
World Health Organization. WHO helmet initiative. World Health
Forum 1992;13:266-7.
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