Association between bicycle helmet legislation, bicycle safety education, and use of bicycle helmets in children

Objective: To determine the association between bicycle helmet legislation and bicycle safety education and the use of bicycle helmets by children under age 16 years. Design: Anonymous questionnaire and direct observations of bicycle helmet use. Setting: Four predominantly white, upper-middle class suburbs of Cleveland, Ohio. Participants: All students in grades 1 through 7 attending public school on the day of the survey and children riding bicycles in a direct observational study. Interventions: Beachwood had bicycle helmet legislation and safety education. Orange had only bicycle helmet legislation. Pepper Pike and Moreland Hills did not have bicycle helmet legislation or safety education. Results: In Beachwood, 416 (67.6%) of 615 children who owned a bicycle reported always wearing their helmets, and 72 (85%) of 85 children directly observed were wearing bicycle helmets. In Orange, 103 (37.2%) of 277 children who owned bicycles reported always wearing helmets, whereas 41 (17.9%) of 229 children in Moreland Hills and 78 (21.5%) of 362 children in Pepper Pike reported always wearing helmets. Helmet use was significantly (P
Bicycle safety education combined with legislation requiring children to wear bicycle helmets may be effective in increasing bicycle helmet use. Elementary school children in four neighboring communities of similar racial and socioeconomic makeup answered a survey on safety, including frequency of bicycle helmet use. One community had a helmet ordinance and had conducted an extensive helmet promotion campaign in the schools. Another community had a helmet ordinance but no education program. The other two communities had neither regulations nor education concerning bicycle helmets. Only 18-22% of children who owned bicycles in these towns indicated they always wore helmets, compared with 37% in the community with legislation alone and 68% in the community with both legislation and education. These results suggest that while helmet legislation is somewhat effective in increasing use, legislation plus safety education can encourage even more children to use bicycle helmets.