Effectiveness of a State Law Mandating Use of Bicycle Helmets among Children: An Observational Evaluation

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Effectiveness of a State Law Mandating Use of
Bicycle Helmets among Children An Observational
Evaluation

• Dafna Kanny, PhD
• Richard A. Schieber, MD, MPH
• Vickie Pryor, RN, MPH
• Marcie-jo Kresnow, MS

AJE 2001154(11)1072-1076
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Learning Objectives

• Identify the scope of bicycle helmet use among
  children and state legislation
• Describe the effectiveness of a state law for
  bicycle helmet use among children
• Provide recommendation for such legislation

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Bicycling in U.S. Children 5-14 Years

• 28 million riders
• Pedal cyclist injury
• 200 deaths
• 100,000 ED visits
• Brain injury
• 125 deaths (65)
• 20,000 ED visits (20)

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Helmet Use in U.S. Children 5-14 Years

• Helmets reduce risk by 69 -88
• 50 own a helmet
• Only 25 always wear helmet

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Bicycle Helmet Use Legislation
Post-Law 47 (1991) 49 (1995) 83 (1992)
Pre-Law 4 (1990) 25 (1994) 36 (1990)
Study Maryland, USA (Cote et al.,
1993) Oregon, USA (Ni et al., 1997) Victoria,
Australia (Cameron et al., 1994)
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Bicycle Helmet Use Legislation in the U.S.

• Only 18 states and 80 cities have helmet laws

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1997 Florida Law

• Children under 16
• 64 of 67 counties adopt the law
• 3 counties legally opted out

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Elementary School Observations in Florida, Four
Counties

• Pre (1991) 5 helmeted
• Post (1992) 15 helmeted
• Intervention
• Education
• Policy
• Media promotion
• Helmet distribution

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Elementary School Observations in Florida, Duval
County

• Pre (1996) 13 helmeted
• Post (1998) 73 helmeted
• Intervention
• Education
• Helmet distribution
• Legislation

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Purpose

• How well do Duval County results represent the
  state?
• How beneficial was the state law?
• Which counties have the greatest need for
  intervention?

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Inclusion Criteria

• Any Florida public elementary school with
• Grades K-5
• No prohibition against cycling to school
• At least one rider

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Study Population

• 55/64 intervention counties with a law
• 3/3 control counties without a law
• Total 1,015/ 1,064 schools (95 response rate)
• Total 21,763 children (unit of analysis)
  

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Observation Methods

• Spring 1999
• Unobtrusive observations by school official of
  bicycle rack
• 1 day 1 time only
• Variables
• Bicycle helmet use, gender, race (W, B, O)

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Helmet Use by Law
Helmet (Outcome)
-
16,907 (79.3) 4,406 (20.7) -
148 (32.9) 302 (67.1)
21,313 450
Law (Exposed)
Crude Prevalence Ratio (PR) 2.4 (2.1 - 2.8)
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Helmet Use by Gender
Helmet
Yes No

10,941 (77.5) 3,180 (22.5)
6,114 (80.0) 1,528 (20.0)
14,121 7,642
Boys Girls
2 18.7, df1 p lt .001
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Helmet Use by Race
Helmet
Yes No

13,274 (82.2) 2,880 (17.8)
1,893 (60.8) 1,220 (39.2) 1,888
(75.6) 608 (24.4)
White Black Other
16,154 3,113 2,496
2 714.9, df2 p lt .001
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Summary Helmet Use by Law
Prevalence Ratio
(95 CI)
Crude 2.4
(2.1, 2.8)
Adjusted 2.3
(2.0, 2.6) (Gender, Race)
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Conclusions

• Children from counties with a state bicycle
  helmet law were twice as likely to wear bicycle
  helmets
• Gender and race did not confound this
  relationship

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Limitations

• Few covariates possible
• No pre-law data collected
• School policy and its enforcement were not
  reported sufficiently

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Advantages

• Statewide survey, nearly all schools
• All elementary grades
• Observational, not self-reported
• Comparison group
• Gender and race also considered

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Recommendations

• Encourage the implementation
• and evaluation of
• Healthy People 2010 objective

All 50 states should have laws requiring bicycle
helmets for riders (Objective 15-24)