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Bicycle helmet giveaway programs may increase use of helmets, but the increase may be only temporary. The Texas program increased used by 7th and 8th grade students from 3% to 38% by the end of the school year, but during the summer, use fell to 5%. This was despite the fact that 96% of the students agreed that helmet use improved safety, and 68% said they thought helmets should be worn whenever riding a bicycle. All spot observations of students showed 0% helmet use., Objective. To determine the effect of a bicycle helmet giveaway program on helmet use among children. Methods. In 1995, a bicycle helmet giveaway program was conducted in two rural towns in Texas. Helmets were given to all 403 school children in kindergarten through grade 8. Helmet education, a bicycle rodeo, and incentives to increase helmet use were part of the program. Observations of helmet use were made before the helmet program began and after the program at several intervals throughout the school year and during the summer. A self-reported survey questionnaire was administered to children in grades 4 through 8 before the helmet program began and at several intervals during the school year to determine their attitudes about helmet use, safety perceptions, and peer pressure. A questionnaire also was administered to the parents of these children to determine attitudes and bicycle helmet use among parents. Results. Helmet use increased from 3% before the giveaway to 38% at the end of the school year, 7 months later. However, during the subsequent summer, helmet use decreased to 5%. Helmet use among 7th- and 8th-grade students was 0% at all observations periods after the giveaway. Even though 96% of all students thought that helmet use increased riding safety and 68% thought helmets should be worn at all times when riding, only 25% thought that their friends would approve of helmet use. Most parents also believed that helmets increased riding safety and should be worn, but only 23% reported always wearing one when riding a bicycle. Conclusions. Bicycle helmet giveaway programs can increase helmet use temporarily, but they may not be sufficient to sustain it. This program was not effective among 7th- and 8th-grade students. Pediatrics 1998;101: 578-582; bicycles, helmets, children., ABBREVIATION. K-8, kindergarten through grade 8. Approximately 66.9 million Americans rode bicycles in 1991, and approximately half were [is less than] 21 years old.[1] Although bicycle riding might seem harmless, [...]

Few children appear to be using bike helmets. Researchers analyzed data from a 1991 nationwide household survey that included interviews with 399 parents or guardians of children younger than 15 regarding bicycle and helmet use. Although one-quarter of the children had helmets, only 15% of the overall group wore helmets all or most of the time. Almost all children wearing helmets did so because of the insistence of family members for safety reasons, but 12% of respondents cited legal requirements as a factor. Helmet use decreased with age. Helmet use was four times more likely in households where someone had attended college and 4.5 times more likely when the child had had an injury needing a doctor's care. Children were more likely to wear helmets when riding in traffic, on long rides, and when reminded. The most common reason for not wearing one was that the child forgot., Objective. To describe and evaluate the helmet use patterns of children younger than 15 years of age in the United States. Methods. A national telephone survey of bicycle riders was conducted by means of the Mitofsky-Waksberg method of random-digit dialing, a survey method intended to give all telephone numbers in the continental United States an equal probability of selection. Based on information collected in the survey, a logistic regression model was used to determine and quantify the factors associated with helmet use. Results. Information was collected on the bicycle and helmet use patterns of a national sample of 399 children younger than 15 years of age who rode bicycles during the year preceding the survey. This sample projects to the approximately 26.4 million children who are estimated to have ridden bicycles in 1991. About 26% of all child riders owned or had the use of bicycle helmets, and about 15% were reported to have used their helmets all or more than half of the time when riding. Information is provided on the reasons the children did or did not wear helmets. The logistic regression analysis shows that helmet use by children is systematically related to their personal characteristics e& age and whether they had previously had bicycle-related accidents requiring medical attention), riding patterns (eg, riding surface), and household demographic characteristics eg, geographic location and whether household members had attended college). Conclusions. Helmet use rates among children remain low. Less than one fifth of the children who rode bicycles wore helmets all or more than half of the time in 1991. However, based on comparisons with earlier studies, the results of the analysis suggest that helmet use rates have been rising. Pediatrics 1996,97:166-173; bicycle helmets, survey data, logit analysis, children., ABBREVIATIONS. CPSC, Consumer Product Safety Commission; MSA, metropolitan statistical area; OR, odds ratio. Based on estimates from the US Consumer Product Safety Commission (CPSC), there are more than 0.5 million [...]

Subsidizing the purchase of bicycle helmets among low-income families may not increase overall helmet use. Researchers offered the sale of bicycle helmets at a reduced rate of $10 to encourage helmet usage among children of low-income families in Toronto, Canada. Children aged from 5 to 12 years old were observed during 1,800 cycling hours. Over a period of three years, general helmet use increased from 3.4 percent to 28% among low-income and high-income residential areas. However, children in the subsidized low-income area were seen using bicycle helmets at a similarly low rate of 18% compared to other low-income areas without such subsidies. Although helmet sales and ownership increased substantially, the availability of less expensive helmets failed to encourage more active use among low-income children. Alternative methods need to focus on changing the behavior among a higher percentage of children. Upcoming legislation may also increase the rate of wearing bicycle helmets., Objective. 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 hemet use throughout the study community. Design. A prospective, controlled, before-and-after study. Subjects. Bicycling children 5 to 14 years of age from areas of low average family income. Setting. A defined geographic community within a large urban Canadian city. Intervention. 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. Main Outcome Measure. Helmet use was determined by direct observation of more than 1800 bicycling children. Results. 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%. Conclusions. 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. Pediatrics 1995; 96:283-287; bicycle helmet, low-income families, bicycle-related head injury; subsidy program., Bicycle-related trauma accounts for at least 10% of all injury deaths in school-age children, 5 to 14 years of age.(1) In the province of Ontario, bicycle-related injuries account for 15% [...]

A school-based, bicycle helmet promotion program may increase helmet use among children from high-income families but not among those from low-income families. Increased helmet use could prevent a significant number of bicycle-related head and neck injuries in children. A study examined the effectiveness of a school-based bicycle helmet promotion program in two high-income and two low-income schools in an urban area of Canada. These schools were compared to 18 that did not have a bicycle helmet promotion program (the control schools). The number of children who used a helmet increased at all of the schools between 1990 and 1991. The increase in helmet use was similar at the low-income schools with and without a helmet promotion program. On the other hand, helmet use by children at the high-income schools rose dramatically after the program compared to high-income children who did not go through the program.

Although bicycle helmets are effective in preventing head injuries, use of helmets among children remains infrequent. In response to the bicycling deaths of two children, Howard County, Maryland, became the first US jurisdiction to mandate use of bicycle helmets for children. Schoolchildren were lectured by police about the law before its enactment. Prelaw and postlaw helmet use was observed in Howard County and two control counties: Montgomery (which sponsored a community education program) and Baltimore County (no helmet activities). Prelaw crude helmet use rates for children were 4% (95% confidence interval [CI] 0% to 10%) for Howard, 8% (95% CI 3% to 13%) for Montgomery, and 19% (95% CI 5% to 33%) for Baltimore. Postlaw rates were 47% (95% CI 32% to 62%), 19% (95% CI 11% to 27%), and 4% (95% CI 0 to 11%), respectively. The rate of bicycle helmet use by Howard County children is now the highest documented for US children. A similar increase in helmet use among children younger than 16 years nationwide could prevent about 100 deaths and 56 000 emergency-department-treated head injuries annually. Physicians and other health professionals should consider proposing and supporting the Howard County approach in their communities.

Bicycle injuries cause 600 deaths and 300,000 visits to the emergency room in children under age 15 each year. In many of the injuries and in most cases of death, a head injury is involved. Despite these figures, very few children wear helmets or other protective head gear when riding their bicycles. Helmets have been shown to greatly reduce the risk of head injuries in bicycle accidents. This study examined whether promoting the use of a helmet to a youngster who is in an emergency room for a bicycle-related injury would be effective in motivating the youngster or his or her family to buy a helmet. The study randomly placed children visiting an emergency room for a bicycle-related injury into two groups, a control group and a group that received encouragement to use a helmet. A total of 334 children were involved in the study, 161 receiving the information (intervention group) and 173 in the control group. Results showed that when a follow-up was performed two to three weeks after the emergency room visit, 15 (9.3 percent) in the intervention group and 14 (8 percent) in the control group had purchased a helmet. These results indicate that the intervention used in this study to promote the use of helmets by bicyclists was not effective. Further studies are needed to find an effective way to encourage helmet use in order to decrease the risk of head injury. (Consumer Summary produced by Reliance Medical Information, Inc.)

Greater use of bicycle helmets and redesign of bicycle helmets could reduce head and face injuries in children. Researchers using national death and injury data calculated how many deaths and injuries could have been prevented in children younger than 20 by greater use of bicycle helmets. On average, 247 children experience brain damage and 140,000 experience head injury annually. As many as 184 deaths and 116,000 head injuries annually could have been prevented by bicycle helmets. Redesigning helmets to protect the lower face could potentially prevent an additional 19,000 chin and mouth injuries., Objective. To estimate the potential benefit of increasing bicycle helmet use among children and adolescents in the United States. Design. All bicycle-related deaths (Multiple Cause of Death Public Use Data Tapes, 1989 through 1992) and bicycle-related injuries treated in sampled emergency departments (National Electronic Injury Surveillance System, 1989 through 1993) were used to calculate traumatic brain injury-associated death and head injury rates per 1000 000 US residents. Preventable injures and deaths were estimated by calculating the population attributable risk of head injury due to nonuse of bicycle helmets. Patients. US residents aged O through 19 years who were injured or who died as a result of a bicycle crash. Results. An average of 247 traumatic brain injury deaths and 140 000 head injures among children and adolescents younger than 20 years were related to bicycle crashes each year in the United States. As many as 184 deaths and 116 000 head injuries might have been prevented annually if these riders had won' helmets. An additional 19 000 mouth and chin injuries were treated each year. The youngest age groups had the highest proportions of both head and mouth injuries. Conclusion. There continues to be a need to advocate for greater use of bicycle helmets, particularly among young children. Helmet design changes should be considered to prevent mouth injuries. Pedriatics 1996;98: 868-870; children, traumatic brain injury, head injury, mortality, injury, bicycles, helmets., ABBREVIATIONS. CPSC, Consumer Product Safety Commission; TBI, traumatic brain injury; RSE, relative sampling error; PAR, population attributable risk; RR, relative risk. Bicycle riding is a common activity among American children [...]

Helmet use appears to decrease the severity of injuries among children who are thrown or fall from a horse. Records were examined for 30 children who were seen over a two-year period at the University of Virginia pediatric emergency department after falling off a horse. Twenty had been wearing a helmet. The average score on an injury scoring system was 13 for non-helmeted children versus 3 for helmeted children. Five helmeted children had a head injury, of whom one was admitted for overnight observation. Five non-helmeted children had a head injury: three were admitted to the hospital, two of these to intensive care, and the third child died during surgery. Injury severity and death rates among non-helmeted riders were equivalent to those of a pedestrian being struck by a car. Interestingly, helmeted riders had less severe injuries generally, which suggests other factors may play a role. Perhaps helmet use also is associated with less risky riding practices., ABSTRACT. Objective. To assess the impact of helmet use on the pattern, and severity of pediatric equestrian injuries. Design. A prospective observational study of all children less than 15 years [...]

A city-wide campaign to promote bicycle helmet use by children may significantly increase their use and decrease cycling-related head injuries. In 1986, Seattle, WA instituted an intensive helmet-promotion campaign, including media publicity, special events, school programs and discount coupons for purchasing helmets. Observed helmet use by children on bicycles increased from 5.5% in 1987 to 40.2% in 1992. White children used helmets more than black or Asian children. Children living in high-income areas had a use rate of 44.4%, but even in low-income areas helmet use was 31.6%. Children riding with adults wearing helmets had the highest use rate. A large health maintenance organization reported that cycling-related head injuries declined 66.6% among children aged five to nine years, and 67.6% among children aged 10 to 14 during the same time period., Objective. To describe the impact of a community bicycle helmet campaign on helmet use and the incidence of bicycle-related head injuries. Setting. Metropolitan community and a large health maintenance organization. Interventions. Communitywide bicycle helmet campaign. Outcomes. Rate of observed bicycle helmet use in the community and incidence of bicycle-related injuries in an health maintenance organization population. Results. Helmet use among school-aged children increased from 5.5% in 1987 to 40.2% in 1992. Bicycle-related head injuries decreased by 66.6% in 5- to 9-year-old and 67.6% in 10- to 14-year-old members of an health maintenance organization. Conclusions. Educational campaigns can increase helmet use and decrease the incidence of bicycle-related head injury. Pediatrics 1994,93:567-569, bicycle-related head injury, bicycle helmet, educational campaign.

Research has demonstrated that helmets protect against head injury during bicycle crashes. Several investigators have shown that large-scale, community-wide programs can increase the rate of helmet use by children. The objective of this research was to determine whether helmet use had changed over a 5-year period in a community with no formal programs designed to increase the use of helmets. In 1985 and again in 1990, project staff observed student bicyclists arriving at four elementary schools, three middle schools, three high schools, and one university campus. The same schools were used both years. There was no significant increase in the percentage of students who used helmets at the middle schools (0 both years), the high schools (1.85% vs 1.45%), or the university (10.0% vs 4.0%). At the four elementary schools, helmet use increased from 1.85% in 1985 to 17.1% in 1990. Much of this increase was attributable to one school at which helmet use increased from 4.4% to 21.4%. This school, and no others, had begun teaching about helmet use in the classroom. The results suggest that (1) helmet use will not increase at the middle school level or higher without specific interventions and (2) simple, low-cost, classroom interventions can increase helmet use by elementary school children. Pediatrics 1992;89:78-80;

Bicycling remains one of the most popular recreational sports among children in America and is the leading cause of recreational sports injuries treated in emergency departments. An estimated 23 000 children younger than 21 years sustained head injuries (excluding the face) while bicycling in 1998. The bicycle helmet is a very effective device that can prevent the occurrence of up to 88% of serious brain injuries. Despite this, most children do not wear a helmet each time they ride a bicycle, and adolescents are particularly resistant to helmet use. Recently, a group of national experts and government agencies renewed the call for all bicyclists to wear helmets. This policy statement describes the role of the pediatrician in helping attain universal helmet use among children and teens for each bicycle ride., ABBREVIATIONS. ANSI, American National Standards Institute; ASTM, American Society for Testing and Materials; CPSC, Consumer Product Safety Commission. BACKGROUND Bicycling continues to be one of the most popular recreational sports [...]

Objective. To determine why people do or do not wear helmets while bicycling. Methods. A survey was conducted from August through October 1999. Two survey areas were chosen for this study: local public schools and paved bicycle trails. For the school arm of the study, 3 public elementary, middle, and high schools were selected from 3 different regions of Rochester, Minnesota, for participation in the study. For the bicycle arm of the study, 3 paved trails located in southeastern Minnesota were selected. A total of 2970 surveys were distributed to the public school system, and 463 surveys were collected from bicyclists on the paved bicycle trails. The survey population was split into 3 age categories for analysis: child (7-10), adolescent (11-19), and adult (older than 19). Results. Of the 2970 surveys distributed to Rochester public schools, 2039 (69%) were returned for analysis. Seventy-eight of the surveys that were completed in the public school system were discarded for the following reasons: age [is less than] 10 years (35), insufficient completion (24), and selection of every reason for not wearing a bicycle helmet (19). A total of 463 surveys were completed on the 3 paved bicycle trails. One survey from the paved bicycle trail arm of the study was discarded because of insufficient completion. The total number of surveys used for statistical analysis was 2424. The distribution of male (52.7%) and female (47.3%) participants was similar. No significant difference in bicycle helmet use was found between genders. The age groups with the highest rate of bicycle helmet use were 50 to 59 years (62%) and older than 59 years (70%). The age groups with the lowest rate of bicycle helmet use were 11 to 19 years (31%) and 30 to 39 years (30%). The most common reasons given for not wearing a bicycle helmet were "uncomfortable," "annoying," "it's hot," "don't need it," and "don't own one." Bicycle helmet use was significantly influenced by peer helmet use in all 3 age groups. Children also were more likely to wear a bicycle helmet when their parents wore bicycle helmets. A majority of respondents in all 3 age groups indicated that bicycle helmets provided either "moderate" or "great" protection from head injury, although significantly more adults (65.9%) than adolescents (43.9%) believed that the protection afforded by bicycle helmets was "great." Despite this belief, a majority of adolescents and adults indicated that there was only a "slight risk" of head injury when bicycling without a helmet. Participants in all 3 categories were more likely to wear a bicycle helmet when they indicated either that there was a "great risk" of head injury when bicycling without a helmet or that helmets provided "great protection" from head injury. Adolescents and adults who believed that bicycling without a helmet put one at "great risk" for head injury also were more likely to indicate that helmets provided "great protection" from head injury. Conclusions. The prevalence of bicycle helmet use remains low despite research indicating the high level of head injury risk when bicycling without a helmet and the significant protection afforded by bicycle helmets. With the information provided by this survey, a well-designed intervention to increase the use of bicycle helmets can be implemented. Suggestions for a campaign to promote an increase in bicycle helmet use include focusing efforts on males and females between 11 and 19 years and 30 and 39 years of age; educating the public on new bicycle helmet designs that address comfort, ventilation, and fashion; educating adolescents on the significant protection from head injury afforded by bicycle helmets; and educating the public on the risk and severity of head injury associated with bicycling without a helmet. The influence of parents and peers on bicycle helmet use may be targeted through education and statements such as, "If you wear a bicycle helmet, you are not only protecting yourself, you are also helping to protect your friends and/or children." Pediatrics 2001;107(7). URL: http:// www.pediatrics.org/cgi/content/full/107/7/e4; bicycle, helmet, injury, accident, prevention.

Two pediatricians discuss the factors that have prevented a nationwide, coordinated effort to encourage children to use helmets when riding a bicycle. Bicycle-related head injuries are common, and helmets are a cheap way to prevent them. Yet surveys have consistently shown that fewer than 25% of all children wear a helmet when bicycling. A 1987 Seattle program raised this percentage to 60% by 1995. However, there is still no national association coordinating these efforts at the national level., The magnitude of bicycle-related head trauma and the protective value of helmets have been known for more than a decade, yet they are worn by all-too-few American children. The exact [...]

Bicycling has become extremely popular in the last 10 years. There were an estimated 100 million cyclists in the United States in 1993.[1] In addition to providing efficient transportation, bicycling [...]

The increasing trend in bicycling has caused an increase in emergency room admissions and accidental deaths. During 1985, many of the 500,000 emergency room visits and 1,300 cycling deaths occurred among children and adolescents. Head injuries are the leading cause of death (70 to 80 percent of the cases) and disability from bicycling. Most of the accidents do not involve cars but are the result of impact with fixed objects and falling. Helmets meeting standards set by the American National Standards Institute are effective in reducing head injuries. In one study helmets reduced head injuries by 85 percent and brain injuries by 88 percent. The low usage rate (less than five percent) can be blamed on lack of awareness, peer pressure and lack of helmet availability in stores selling bicycles. The American Academy of Pediatrics recommends that pediatricians inform parents about the dangers of cycling without protective helmets. Retail stores should urge cycle buyers to also purchase helmets. Standards for helmets should be developed by the Consumer Product Safety Commission. Helmets use should be promoted on television. Advertising campaigns and promotional materials should be developed to encourage the wearing of helmets. (Consumer Summary produced by Reliance Medical Information, Inc.)

"Context: Although using a helmet is assumed to reduce the risk of head injuries in alpine sports, this effect is questioned. In contrast to bicycling or inline skating, there is [...]

Objective. To evaluate the influence of average family income in a geographic area on the effectiveness of helmet legislation on observed helmet use by children (5-14 years). Methods. The study was conducted in East York, a health district of Metropolitan Toronto, in collaboration with the East York Health Unit. In 1996, the total population was 107 822, 11 340 of which were children 5 to 14 years. Census data were used to group the 21 census tracts in East York into 7 geographically distinct areas. The boundaries of these areas are natural barriers to travel, such as expressways, ravines, railway tracks, and hydroelectric power lines. The areas were also ranked according to average family income (based on Statistics Canada data). For analytical purposes, areas were defined as low-, mid-, and high-income areas. Census data profiles of the areas have been previously described. For each consecutive year from 1990 to 1997 inclusive, direct observations of children riding bicycles in East York during the months of April through October were made. In 1995, observations were completed before the introduction of the law on October 1, 1995. Only children who were between 5 and 14 years of age and riding a 2-wheeled bicycle were included in the study. In total, 111 sites across all 7 areas were selected for observation. Observational sites included school yards of all elementary and middle schools (kindergarten to grade 8) and all parks in East York. In addition, 5 major intersections and 5 residential streets from each area were randomly selected. Observers were trained and used a standardized data collection form. A pilot study showed that the data collected by observers were reliable and valid. Observers remained at each site for 1 hour and collected data on helmet use and sex. Ethical approval for the study was obtained from the Hospital for Sick Children Research Ethics Board, the East York Board of Education, and the Metropolitan Separate School Board. The proportion of children who were wearing a bicycle helmet was estimated by year (1990-1997, inclusive), sex (male, female), location (school, park, major intersection, residential street), and income area (low, mid, high). For estimating the effect of legislation on helmet use, data from the year immediately after legislation (1996) were compared with data from the year preceding legislation (1995). The relative risk (RR) of helmet use (after vs before legislation) was calculated along with a 95% confidence interval (CI). Logistic regression analysis was used to adjust for potential confounding variables (sex and location). Results. During the 8-year study period, 9768 observations were made (range: 914-1879 observations per year). The proportion of child cyclists who wore a bicycle helmet increased steadily during the first 4 years of the study period, from 4% in 1990 (34 of 914), to 16% in 1991 (303 of 1879), to 25% in 1992 (383 of 1563), and to 45% in 1993 (438 of 984). During 1994 (460 of 1083) and 1995 (568 of 1227), helmet use remained relatively stable at approximately 44%. Helmet use rose markedly in 1996 (the first year after helmet legislation was introduced) to 68% (818 of 1202) and remained stable at 66% (609 of 916) in 1997. Throughout the study period, girls were consistently more likely to wear helmets than were boys. In total, 47% (1420 of 3047) of girls wore helmets, compared with 33% (2193 of 6721) of boys (RR: 1.43; 95% CI: 1.36-1.50). In addition, children who were riding to school were more likely to use helmets, compared with children who were riding on residential streets, major intersections, and parks. Overall, 48% (1497 of 3129) of children who were riding to school wore bicycle helmets, compared with 32% (2116 of 6639) of children who were riding at other locations (RR: 1.50; 95% CI: 1.43-1.58). Children in the high-income areas were consistently more likely to wear helmets, compared with children in the mid-and low-income areas. Helmet legislation was associated with a significant increase in helmet use by children in East York. In 1995, 46% (568 of 1227) of children wore bicycle helmets, compared with 68% (818 of 1202) of children in 1996 (RR: 1.47; 95% CI 1.37-1.58). The effect of legislation, however, varied by income area. In low-income areas, helmet use increased by 28% after legislation, from 33% (213 of 646) in 1995 to 61% (442 of 721) in 1996 (RR: 1.86; 95% CI: 1.64-2.11). In mid-income areas, helmet use increased by 29% after legislation, from 50% (150 of 300) in 1995 to 79% (185 of 234) in 1996 (RR: 1.58; 95% CI: 1.39-1.80). In high-income areas, helmet use increased by only 4%, from 73% (205 of 281) in 1995 to 77% (191 of 247) in 1996 (RR: 1.06; 95% CI: 0.96-1.17). This finding of a significant increase in helmet use after legislation in low-and mid-income areas but not in high-income areas remained even after logistic regression analysis adjusted for sex and location. Conclusions. This study showed that bicycle helmet use by children increased significantly after helmet legislation. In this urban area with socioeconomic diversity and in the context of prelegislation promotion and educational activities, the legislative effect was most powerful among children who resided in low-income areas. Pediatrics 2003;112:e192-e196. URL: http://www. pediatrics.org/cgi/content/full/112/3/e192; socioeconomic status, bicycle helmet, legislation, injury prevention.

Objective. Childhood bicycle-related head injuries can be prevented through the use of helmets. Although helmet legislation has proved to be a successful strategy for the adoption of helmets, its effect on the rates of head injury is uncertain. In Canada, 4 provinces have such legislation. The objective of this study was to measure the impact of helmet legislation on bicycle-related head injuries in Canadian children. Methods. Routinely collected data from the Canadian Institute for Health Information identified all Canadian children (5-19 years) who were hospitalized for bicycling-related injuries from 1994-1998. Children were categorized as head or other injury on the basis of International Classification of Diseases, Ninth Revision, codes. Rates of head injuries and other injuries were compared over time in provinces that adopted legislation and those that did not. Results. Of the 9650 children who were hospitalized because of a bicycle-related injury, 3426 sustained injuries to the head and face and the remaining 6224 had other injuries. The bicycle-related head injury rate declined significantly (45% reduction) in provinces where legislation had been adopted compared with provinces and territories that did not adopt legislation (27% reduction). Conclusion. This country-wide study compared rates of head injury in regions with and without mandatory helmet legislation. Comparing head injuries with other non-head-injured children controlled for potential differences in children's cycling habits. The strong protective association between helmet legislation and head injuries supports the adoption of helmet legislation as an effective tool in the prevention of childhood bicycle-related head injuries. Pediatrics 2002;110(5). URL: http:// www.pediatrics.org/cgi/content/full/110/5/e60; helmet legislation, bicycling injuries, head injuries, pediatrics, prevention.