Impact of a theory based intervention to increase bicycle helmet use in low income children

Objective—While community interventions to increase bicycle helmet use have increased markedly, few of these studies are theoretically based. The purpose of this study was to determine relationships among PRECEDE model predictors and self reported helmet use among 407 fourth graders from nine low income, non-urban schools. Setting—Low income schools, with high minority populations in eight non-metropolitan Central Texas counties were chosen. Methods—Schools were randomly assigned in a repeated measures design to either classroom only, parent-child, or control groups. School nurses were educated by the researchers to present a head injury prevention program in all but the experimental schools. Researchers made contact by phone with the parents of children in the parent-child group. Results and conclusions—Participation in either of the educational interventions, followed by belief that helmets protect your head (a predisposing factor), and participation in the parent intervention condition, added significant unique variance to the prediction of helmet use after helmet ownership is accounted. These four variables, taken together, account for 72% of the variance in predicting bicycle helmet use.     

School based bicycle safety education and bicycle injuries in children: a case-control study

Objectives—To evaluate possible benefits of a school based bicycle safety education program ("Bike Ed") on the risk of bicycle injury in children.

Methods—A population based case-control study was undertaken in a region of Melbourne, Australia. Cases were children presenting at hospital emergency departments with injuries received while riding bicycles. Controls were recruited by calling randomly selected telephone numbers. Data were collected by personal interview.

Results—Analysis, based on 148 cases and 130 controls aged 9 to 14 years, showed no evidence of a protective effect and suggested a possible harmful effect of exposure to the bicycle safety course (odds ratio (OR) 1.64, 95% confidence interval (CI) 0.98 to 2.75). This association was not substantially altered by adjustment for sex, age, socioeconomic status, and exposure, measured as time or distance travelled. Subgroup analysis indicated that the association was strongest in boys (OR 2.0, 95% CI 1.1 to 3.8), younger children, children from families with lower parental education levels, and children lacking other family members who bicycle.

Conclusions—It is concluded that this educational intervention does not reduce the risk of bicycle injury in children and may possibly produce harmful effects in some children, perhaps due to inadvertent encouragement of risk taking or of bicycling with inadequate supervision.

     

Epidemiology of bicycle injury,head injury,and helmet use among children in British Columbia: a five year descriptive study

Objectives and methods—Data on 1462 injured bicyclists aged 1–19, obtained over a period of five years from the British Columbia Children''s Hospital as part of a national emergency room based program in Canada, were analyzed to describe the epidemiology of injuries, helmet use, and the occurrence of head injuries before the enactment of a new mandatory helmet law. The odds ratio (OR) and 95% confidence interval (CI) were calculated for non-users compared with helmet users. Results—Bicycle injuries comprised 4% of all injuries seen in the five year study period. The proportion of admissions was 12.7% among bicyclists, significantly higher than the 7.9% admissions of all 35 323 non-bicyclist children who were seen during the study period (OR = 1.96, CI = 1.44 to 1.99). Boys were injured more often than girls. The proportion of admissions for boys was 13.8% compared with 10.2% among girls (OR = 1.41, CI = 0.97 to 2.05). More than 70% of injured bicyclists reported no helmet use. The proportion of admissions of injured bicyclists who did not use helmets was always higher than the proportion of admissions of those who used helmets (OR = 2.23, CI = 1.39 to 3.62). Head and face injuries occurred more often among those who did not use helmets (OR = 1.55, CI= 1.18 to 2.04 ). However, there was no excess of minor head injuries among non-users (OR = 1.10, CI = 0.60 to 2.06). Of the 62 concussions, 57 occurred to non-helmet users (OR = 4.04, CI = 1.55 to 11.47). Most injuries occurred in the upper (46.4%) or lower extremities (32.4%). Dental injuries occurred slightly more often among helmet users compared with non-users but this excess was not statistically significant (OR = 1.29, CI = 0.76 to 2.20). Conclusion—The data indicate the need to control injuries by using helmets. A decrease in the number of head injuries and their severity is expected when bicycle helmet use becomes law in British Columbia.     

Helmet promotion in the emergency room following a bicycle injury: a randomized trial

Head injury is the leading cause of serious morbidity and mortality in bicycle accidents. There is good evidence to recommend helmets, yet few children wear them. Following a survey of children presenting to the emergency room with a bicycle injury, helmet promotion was evaluated in a randomized trial. The intervention consisted of physician counseling and take-home pamphlets. The study involved 334 children: 161 in the intervention group and 173 in the control group. In a follow-up telephone call, 2 to 3 weeks later, only 9.3% of the intervention group had purchased helmets, compared with 8.0% of the control group. Families in the intervention group received further counseling during the telephone contact, resulting in one additional purchase at 6-week follow-up. Evidence that a bike injury motivates cyclists to purchase helmets, and the influence of the self-administered questionnaire most likely account for the high purchase rate in the control group. Surprisingly, the helmet promotion intervention, including follow-up phone counseling, made no further impact. The results probably are best explained by a "double threshold" effect. Certain families were easily encouraged to buy a helmet, whereas others were far from ready to adapt this fairly recent innovation as routine cycling equipment. The findings suggest that physicians interested in helmet promotion would do better to participate in the design and implementation of multidisciplinary community campaigns.     

Bicycle helmet use among schoolchildren—the influence of parental involvement and children's attitudes

OBJECTIVE: To study attitudes towards and use of bicycle helmets among schoolchildren; to determine whether these attitudes are associated with the involvement of parents and school in bike safety. SETTINGS: Nine intermediate level schools and five upper level schools in two Swedish municipalities. METHOD: A survey with 1,485 participants aimed at pupils aged 12-15 years conducted during late spring 1997. Associations between parent and school involvement and children's attitudes and helmet use were studied using LisRel analyses. RESULT: At some point during their school years, a majority of the children stopped wearing bicycle helmets. Of 12-13 year olds, 80% said that they had used helmets when they were younger but at the time of the study, only 3% aged 14-15 years used helmets. Use decreased significantly during school years (p<0.001). The majority stated they quit using helmets because they were ugly, silly, uncomfortable, or inconvenient. There was a strong association between parental involvement, children's attitudes, and helmet use. However, parent involvement decreased as the children grew older. CONCLUSION: To increase the voluntary use of bicycle helmets among schoolchildren their attitudes must be influenced. An intervention aimed at both parents and children may be required.     

Evaluation of a bicycle skills training program for young children: a randomized controlled trial

Objective—To evaluate the effectiveness of a skills training program in improving safe cycling behavior, knowledge, and attitudes in young children.

Methods—Grade 4 children from six elementary schools in East York (a borough of Metropolitan Toronto) participated. The intervention—playground based instruction on bicycle handling skills by certified instructors—was randomly allocated to three schools. Altogether 141 children participated: 73 in the intervention group and 68 in the control group, with follow up evaluations available on 117 (83%). The primary outcome was safe cycling behavior (straight line riding, coming to a complete stop, and shoulder checking before a left turn). A self report questionnaire collected data on knowledge and attitudes. Baseline assessments were made in June, with follow up evaluations in September, 1995.

Results—The prevalence of safe cycling behaviors at follow up in the intervention and control groups respectively, were: straight line riding (90% v 88%; p=0.782), coming to a complete stop (90% v 76%; p=0.225), and shoulder checking (0% v 2%; p=1.000). Over time (from baseline to follow up) children in both groups were more likely to maintain straight line riding, less likely to ride on the sidewalk, and less likely to consider that a car had more right to the road.

Conclusions—This brief skills training program was not effective in improving safe cycling behavior, knowledge, or attitudes among grade 4 children.

     

Correlates of children's bicycle helmet use and short-term failure of school-level interventions.

To test the utility of school-level interventions for child bicycle safety and to identify social and behavioral factors associated with children's bicycle helmet use, a two-level intervention was conducted in two suburban elementary schools. Children (N = 209) and parents (N = 125) in school 1 and in school 2 (children, N = 470; parents, N = 364) were surveyed regarding bicycle injuries and helmet use. Children and parents in schools 1 and 2 received literature about bicycle safety and discount coupons for helmet purchase. School 1 was then the target of an intensive safety campaign, including meetings with the school safety committee and the PTA and a classroom presentation to children emphasizing helmet use. Ten months later the same survey was again administered. Children in school 1 were more likely at posttest to believe that helmets were protective (P = .003) but did not differ on other variables. Logistic regression showed that sibling helmet ownership, parental helmet use, and lower parental perceived social barriers to helmet use were independently associated with children's reported helmet use and with parental intent for the child to use a helmet at posttest.     

Cycle helmet ownership and use; a cluster randomised controlled trial in primary school children in deprived areas

Aims: To assess the effectiveness of two different educational interventions plus free cycle helmets, in increasing cycle helmet ownership and use. Methods: A cluster randomised controlled trial was carried out in 28 primary schools in deprived areas of Nottingham, involving 1213 year 5 schoolchildren (age 9 and 10). Children received either a helmet + educational pack (educational pack and order form for free cycle helmet) or a helmet + multifaceted intervention (educational pack, order form for free cycle helmet, school assembly, lesson devoted to cycle helmet education, and an invitation to a school based cycling event). Results: The helmet + educational pack was as effective as the helmet + multifaceted intervention in terms of helmet ownership (OR 1.51, 95% CI 0.50 to 4.58) and wearing (OR 0.98, 95% CI 0.57 to 1.68). Helmet ownership significantly increased from baseline with both interventions, and wearing significantly increased from baseline with the helmet + educational pack. The interventions reduced the inequality in helmet ownership between children residing in deprived and non-deprived areas that had been present prior to the study. Conclusions: An educational pack plus a form to order a free cycle helmet is an effective way of increasing bicycle helmet ownership and use and reduces inequalities in helmet ownership among children in deprived areas. Further work is needed to determine the length of the effect of such interventions.     

Trends in bicycle helmet use by children: 1985 to 1990.

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.     

Promoting bicycle helmet wearing by children using non-legislative interventions: systematic review and meta-analysis.

OBJECTIVES: To assess the effectiveness of non-legislative interventions in increasing bicycle helmet use among children and young people, and to identify possible reasons for differential effectiveness of interventions. DESIGN: Systematic review and meta-analysis. DATA SOURCES: 10 electronic databases were searched up to October 2006. Several other sources of potentially relevant information were identified and examined. REVIEW METHODS: We included randomized controlled trials, non-randomized controlled trials and controlled before-and-after studies of interventions to promote bicycle helmet use, which did not require the enactment of legislation. Participants were aged between 0 and 18 years. MAIN OUTCOME MEASURE: Observed helmet wearing. RESULTS: 13 studies were included in the review and 11 in the meta-analysis. The odds of observed helmet wearing were significantly greater among children and young people in the intervention groups (OR 2.13, 95% CI 1.35 to 3.35). Subgroup analysis indicated that the effect might be greater for community-based studies (4.57, 2.37 to 8.81) and those providing free helmets (4.60, 2.25 to 9.43) than for those providing subsidized helmets (2.11, 1.09 to 4.06) and those set in schools (1.73, 1.04 to 2.89). Evidence for the effectiveness of the interventions was stronger in studies with follow-up periods of 相似文献   

Cycle helmet ownership and use; a cluster randomised controlled trial in primary school children in deprived areas.

AIMS: To assess the effectiveness of two different educational interventions plus free cycle helmets, in increasing cycle helmet ownership and use. METHODS: A cluster randomised controlled trial was carried out in 28 primary schools in deprived areas of Nottingham, involving 1213 year 5 schoolchildren (age 9 and 10). Children received either a helmet + educational pack (educational pack and order form for free cycle helmet) or a helmet + multifaceted intervention (educational pack, order form for free cycle helmet, school assembly, lesson devoted to cycle helmet education, and an invitation to a school based cycling event). RESULTS: The helmet + educational pack was as effective as the helmet + multifaceted intervention in terms of helmet ownership (OR 1.51, 95% CI 0.50 to 4.58) and wearing (OR 0.98, 95% CI 0.57 to 1.68). Helmet ownership significantly increased from baseline with both interventions, and wearing significantly increased from baseline with the helmet + educational pack. The interventions reduced the inequality in helmet ownership between children residing in deprived and non-deprived areas that had been present prior to the study. CONCLUSIONS: An educational pack plus a form to order a free cycle helmet is an effective way of increasing bicycle helmet ownership and use and reduces inequalities in helmet ownership among children in deprived areas. Further work is needed to determine the length of the effect of such interventions.     

Does sharing the cost of a bicycle helmet help promote helmet use?

OBJECTIVE: To determine whether asking for a $5.00 donation for bicycle helmets, compared with distribution free of charge, would affect helmet use among children receiving helmets and an educational intervention from public health clinics. SETTING: Six public health clinic sites in King County, Washington. METHODS: Six participating clinic sites were randomly assigned to either free helmet distribution or to a $5.00 suggested donation for the helmets, stratified by whether a helmet law was in place. Three sites were assigned to each arm. Children who were between 6 and 12 years of age and who reported riding bicycles, but having no bicycle helmets, were eligible. Clinicians distributed helmets and delivered an educational intervention to 506 eligible children, or siblings of children seen at the clinic between March and July 1993. Parents were contacted after helmet distribution to ascertain helmet use. RESULTS: 82% of children whose parents were asked for a copayment and 77% of children who received free helmets were reported to wear their helmets every time they rode their bicycles (p=0.20). The adjusted odds ratio for the association between copayment compared with free helmets and helmet use was 1.66 (95% confidence interval 0.94 to 2.92). CONCLUSIONS: Helmet use was not significantly different among children whose parents were asked for a small copayment, compared with those who received helmets free. Use of copayments can increase helmet use by increasing the number of helmets given to low income children.     

Helmets! All the pros wear them.

OBJECTIVE--To assess the outcome of a multidisciplinary community campaign to increase helmet use and determine the success of a school education and helmet distribution program. DESIGN--Survey research. SETTING--Large metropolitan area and two elementary schools. PARTICIPANTS--Five hundred representative families in a metropolitan area and students enrolled in two elementary schools. INTERVENTIONS--A 1-year-long regional media campaign and a helmet distribution program in one elementary school after 4 weeks of safety instruction. RESULTS--Evaluation of the community component 1 year after initiation of the campaign revealed a 23% awareness of the promotion. Factors associated with wearing a helmet in the community included higher income levels, higher level of education, and male sex. The school component survey revealed that 73% of the children in school A reported helmet use vs 23% in school B. This multifaceted approach to affect helmet use demonstrated variable success in our community. CONCLUSION--This campaign effort achieved its greatest success in promoting community awareness of the importance of helmet use. However, further studies need to be performed to determine the success of the school education and helmet distribution program.     

Injury reporting in Connecticut newspapers

Methods—A commercial service provided all newspaper clippings reporting unintentional injury events between July and September 1995 from 17 daily and 55 weekly newspapers published in Connecticut, USA. Each clipping was reviewed to determine the presence or absence of 35 content variables.

Results—There were 962 articles and excluding 35 editorials, 927 reported injury events and 17% pertained to persons under 21 years. Of the 60% that described motor vehicle collisions only 3% mentioned driver alcohol use, 9% seat belt use, and fewer than 1% airbag use. In the 17 motorcycle and 44 bicycle stories, 29% and 20% respectively, mentioned helmet use. In the 16 articles about house fires only 13% mentioned smoke detector use. There were no significant differences in injury reporting by circulation size.

Conclusions—Newspapers are an important source of public information but are woefully deficient in providing information on injury prevention.

     

An observational study of protective equipment use among in-line skaters

Objectives—To describe the patterns of protective equipment use by in-line skaters in Winnipeg, Manitoba and nearby rural communities.

Methods—In-line skaters were observed for three months in 1996 at 190 urban and 30 rural sites selected using a formal sampling scheme. Age, gender, protective equipment use, skating companions, correct helmet use, and use of headphones were recorded.

Results—Altogether 123 in-line skaters were observed at 61 sites, including one rural site. No skaters were observed at the remaining sites. There were 37 adults and 86 children; 56% were male. Helmet use was 12.2% (95% confidence interval (CI ) = 6.4% to 18.0%), wrist guard use was 16.3% (95% CI = 9.7% to 22.8%), knee pad use was 9.8% (95% CI = 5.2% to 16.4%), and elbow pad use was 7.3% (95% CI = 3.4% to 13.4%). Children were more likely to wear a helmet than teens 12–19 years of age (relative risk (RR) = 30, 95% CI = 4.01 to 225). Adults were more likely to wear wrist guards than children (RR = 4.32, 95% CI = 1.87 to 9.94). No gender differences were found. Incorrect helmet use was documented in four skaters; three skaters were wearing headphones.

Conclusions—Low rates of protective equipment use were documented in our region, significantly lower than those reported in the literature. Barriers to equipment use are not known, and should be examined by further study. In-line skating safety programs should be developed, promoted, and evaluated. Teens should be targeted for future preventive efforts.

     

Harstad injury prevention study: prevention of burns in young children by community based intervention

Objective—To describe the long term effectiveness of a community based program targeting prevention of burns in young children.

Design—Quasiexperimental.

Setting—The Norwegian city of Harstad (main intervention), six surrounding municipalities (intervention diffusion), and Trondheim (reference).

Participants—Children under age 5 years in the three study populations.

Methods—Outpatient and inpatient hospital data were coded according to the Nordic system, and collected as part of a national injury surveillance system. Burn data collection started in May 1985. The first 19.5 months of the study provided baseline data, while the last 10 years involved community based intervention, using a mix of passive and active interventions.

Results—The mean burn injury rate decreased by 51.5% after the implementation of the intervention in Harstad (p<0.05) and by 40.1% in the six municipalities (not significant). Rates in the reference city, Trondheim, increased 18.1% (not significant). In Harstad and the six surrounding municipalities there was a considerable reduction in hospital admissions, operations, and bed days. Interventions with passive strategies were more effective, stove and tap water burns being eliminated in the last four years, while active strategies were less effective.

Conclusions—A program targeting burns in children can be effective and sustainable. Local injury data provided the stimulus for community action.

     

Bicycle helmet use among American children, 1994.

OBJECTIVE: To estimate ownership and use of bicycle helmets among children in the US in 1994. METHODS: As part of a 1994 national telephone survey of 5,238 randomly dialed households, adult respondents reported data on bicycle helmet ownership and helmet use among 1,645 child bicyclists. Data were weighted to provide national estimates. RESULTS: It is estimated that 72.7% of children 5-14 year olds ride bicycles, that is, 27.7 million child bicyclists. Of the bicyclists, 50.2% have a helmet and 25.0% reportedly always wore their helmet when cycling. Reported helmet ownership and use increased with income and educational level and decreased with age. Among regions of the US, those with the highest proportion of states with helmet use laws in 1994 also had the highest proportion of helmet use among children. Among child bicyclists who had been seen by a health care provider in the preceding 12 months, 43.9% of those counseled to wear a bicycle helmet were reported to comply compared with 19.1% of those seen by a provider but not so counseled (p < 0.001). CONCLUSIONS: To meet the year 2000 objective of 50% of bicyclists wearing helmets, use among American children will have to double. Concerted and increased efforts to promote the wearing of bicycle helmets are necessary.     

New Zealand children's involvement in home activities that carry a burn or scald risk

Objectives—The self reported involvement of elementary schoolchildren from Auckland, New Zealand was measured for home activities that carry a burn or scald risk.

Method—A survey was conducted with 421 children aged 7–13 years. The survey asked children whether they carried out specific home activities involving hot water, fire, or appliances that carry a burn risk. It also measured their knowledge of the three basic fire safety messages taught to New Zealand schoolchildren by the fire service.

Results—The results showed that although involvement levels increased with age, the majority of even the youngest children reported carrying out a number of the risky activities, such as preparing hot drinks, running their own baths, or using a microwave without help. No gender differences were found in the number of risky activities engaged in. Significant ethnic differences were found, with higher risk involvement by indigenous Maori and children of Pacific Island descent than children of European or Asian descent. Each of the three fire safety messages were correctly identified by between 79%–91% of the children.

Conclusions—Investigation of children's involvement in household activities that carry an injury risk may help in the design of prevention strategies, including school based education. Prevention efforts need to acknowledge the ages at which children begin to undertake specific household tasks, including those that involve care for younger siblings, and be attuned to the needs of different ethnic groups.

     

All terrain vehicle ownership, use, and self reported safety behaviours in rural children

Objectives—To describe all terrain vehicle (ATV) ownership, access, use, and safety behaviours in rural Manitoba children.

Methods—Questionnaire administered to a convenience sample of grade 6 students attending an agricultural fair.

Results—162 grade 6 children participated. The mean age was 11.4 years, and 46% were male. 125 students (77%) reported having access to ATVs, including 69 four wheeled, 24 three wheeled, and four both three and four wheeled ATVs. ATV experience was reported in 95 students, significantly more often in males and among those with a family owned ATV, with no difference between children living on a farm and in a town. Use of helmets and protective clothing was inadequate (10–40%), and dangerous riding habits common, with males and children living on a farm reporting significantly fewer desirable behaviours.

Conclusions—ATVs are commonly used by children in rural Manitoba, with inadequate protective gear and dangerous riding habits. Mandatory rider training, consumer and dealer education, and legislation enforcement could improve ATV safety in this population.