Bicycle helmet laws and educational campaigns: an evaluation of strategies to increase children's helmet use

Objectives. The passage of a mandatory bicycle helmet law for children in Howard County, Maryland, provided an opportunity to compare legislation and education as strategies to increase helmet use. Methods. In 1991, a survey was mailed to fourth-, seventh-, and ninth-grade students attending a stratified sample of public schools in Howard County and in two similar suburban/rural counties without helmet laws. Results. Of 7217 students surveyed, 3494 responded (48.4%). Self-reported helmet use in Howard County rose from 11% to 37% after the law and accompanying educational campaign went into effect. Helmet changed from 8% to 13% in Montgomery County, where educational efforts were undertaken, and from 7% to 11% in Baltimore County, where helmet promotion activities were minimal. Predictors of helmet use included having friends who wore helmets, believing helmet laws are good, being in fourth grade, living in Howard County, and using seat-belts regularly. Conclusions. Legislation combined with education appears to increase bicycle helmet use substantially more than does education alone. The Howard County law may be considered successful model of a strategy to increase children's helmet use. (Am J Public Health. 1993;83:667-674)
Combining education with legislation is the most effective means of encouraging bicycle safety helmet use among children. Residents of three contiguous counties in Maryland were surveyed on bicycle helmet use. Howard County was the only one with a mandatory helmet law for children under 16. Implementation of the law was combined with an educational safety program to encourage helmet use. In an adjacent county, Montgomery, there was no legislation, but there was a comprehensive bicycle safety education program incorporated into the school curriculum and involving local media. The third county, Baltimore, had no helmet legislation and no safety education program. Children in grades four, seven and nine were mailed questionnaires that were to be filled out anonymously. Children's helmet use rose from 11% to 37% after the implementation of the law and bicycle safety campaign in Howard County. Nonetheless, only a small percentage of the respondents indicated that they regularly wore safety helmets.