The cost effectiveness of three programs to increase use of bicycle helmets among children.

Each year in the United States, 280 children die from bicycle crashes and 144,000 are treated for head injuries from bicycling. Although bicycle helmets reduce the risk of head injury by 85 percent, few children wear them. To help guide the choice of strategy to promote helmet use among children ages 5 to 16 years, the cost effectiveness of legislative, communitywide, and school-based approaches was assessed. A societal perspective was used, only direct costs were included, and a 4-year period after program startup was examined. National age-specific injury rates and an attributable risk model were used to estimate the expected number of bicycle-related head injuries and deaths in localities with and without a program. The percentage of children who wore helmets increased from 4 to 47 in the legislative program, from 5 to 33 in the community program, and from 2 to 8 in the school program. Two programs had similar cost effectiveness ratios per head injury avoided. The legislative program had a $36,643 cost and the community-based one, $37,732, while the school-based program had a cost of $144,498 per head injury avoided. The community program obtained its 33 percent usage gradually over the 4 years, while the legislative program resulted in an immediate increase in usage, thus, considering program characteristics and overall results, the legislative program appears to be the most cost-effective. The cost of helmets was the most influential factor on the cost-effectiveness ratio. The year 2000 health objectives call for use of helmets by 50 percent of bicyclists.(ABSTRACT TRUNCATED AT 250 WORDS)     

What school children need to learn about injury prevention

Unintentional injuries are the leading cause of death and a major cause of morbidity among school age children. A survey of the educational needs concerning injury prevention of a group of fifth and sixth grade children (ages 10-12) in Holliston, MA, revealed educational deficiencies, including bicycle safety, seatbelt use, firearms use, and water safety. It is well known that the use of helmets can prevent bicycle injuries. Yet, not one of the children in this study reported using a bicycle helmet. Although most States have laws requiring seatbelts for young children, school age children are not covered by this legislation. The hazards of firearms have been well-documented. But it is clear that the children surveyed were in need of education about firearms; nearly half had used some form of firearms. Individual counseling by pediatricians combined with school- and community-based programs can address injury prevention. It is anticipated that many pediatricians will begin using the questionnaire for school age children as that component of the American Academy of Pediatrics Injury Prevention Program is introduced.     

Injury Control Recommendations for Bicycle Helmets

ABSTRACT: These guidelines were developed by the Centers for Disease Control and Prevention for state and local agencies and organizations planning programs to prevent head injuries among bicyclists through use of bicycle helmets. The guidelines contain information on the magnitude and extent of the problem of bicycle-related head injuries and potential impact of increased helmet use; characteristics of helmets, including biomechanical characteristics, helmet standards, and performance in actual crash conditions; barriers that impede increased helmet use; and approaches to increasing use of bicycle helmets within the community. In addition, bicycle helmet legislation and community educational campaigns are evaluated. (J Sch Health. 1995;65(4):133–139)     

Head injuries after serious bicycle accidents

Between 1987 and 1988 there were 47 serious or fatal injuries among bicycle riders in the city of Tel Aviv-Yafo (Serious injury was defined as being hospitalized for at least 24 hours). Collisions with vehicles, mostly cars, were responsible for about 80% of these cases. Two-thirds of the accidents occurred in adults aged 20 and over.We were able to trace the records of 24 of the 47 who were injured. Head trauma was the most common form of severe injury, occurring in 11 of the 24 cases. Two of the 11 died instantly and one died after 14 days of hospitalization, all from severe brain damage. Eight suffered severe head trauma, 7 of which had brain injury and 2 of the 7 were left with severe residual brain damage. In view of the efficacy of bicycle helmets in preventing head trauma there is a great need to expand their use among bicyclists in Israel.Corresponding author.     

Injuries to bicyclists in Wuhan, People's Republic of China.

OBJECTIVES: This study examined the morbidity and mortality from bicycling injuries in Wuhan, China. METHODS: Police department data for the year 1993 complemented by data from emergency room interviews were analyzed. RESULTS: The death rate from bicycling injuries was estimated as 2.2 per 100000 population, more than seven times the rate for the United States. At least 79% of the fatalities and 17% of the emergency room cases sustained head injuries, the majority (71%) of which resulted from contact of the head with the concrete or asphalt road. None of the patients was wearing a helmet at the time of injury, and helmet use among the general bicyclist population was nonexistent. CONCLUSIONS: Bicycle-related head injury is an important public health issue in China. The effectiveness of safety helmets in developing countries needs to be evaluated.     

Promotion of bicycle helmet use among schoolchildren: a randomized clinical trial

Although bicycle helmets have been shown to reduce the rates of head injuries and brain injuries from bicycle mishaps, use of helmets is very uncommon. We compared a comprehensive awareness program to increase bicycle helmet use among schoolchildren to the impact of that same awareness program plus a bicycle helmet subsidy. Results showed no impact of the educational program (no children observed riding to school wore helmets before or after the program). The proportion of helmet wearers at the school that obtained the subsidy increased from 0% to 22% (p = 0.036). An educational program in conjunction with a subsidy may have a significant impact on bicycle helmet use.     

Pedal-cycle injuries among children aged <6 years--Wisconsin, 2002-2004

Measures to improve pedal-cycle safety and increase helmet use often target school-age children rather than younger children, even though preschool children wearing helmets have fewer injuries and are more likely to wear helmets in the future, compared with children who do not wear helmets. Children aged <6 years also use pedal cycles; whether they are passengers on a parent's bicycle, riding a tricycle or pedal car, or learning to ride a bicycle, these young cyclists often sustain injuries. To provide guidance for intervention strategies targeted to young children in Wisconsin, CDC and the Wisconsin Division of Public Health analyzed data collected from January 1, 2002 through December 31, 2004, from all nonfederal emergency departments (EDs) and hospitals in Wisconsin regarding pedal-cycle injuries among children aged <6 years. This report describes the results of that analysis, which indicated that, during 2002--2004, a total of 2,046 ED visits by Wisconsin residents aged <6 years for pedal-cycle injuries occurred; for 1,305 (63.8%) of these visits, the primary diagnosis was a head or neck injury. These findings underscore the need for interventions designed to reduce head and neck injuries in the youngest users of pedal cycles.     

A case-control study of the effectiveness of bicycle safety helmets in preventing facial injury.

In a case-control study we sought to assess the potential effectiveness of helmets in preventing facial injuries. Our study included 212 bicyclists with facial injuries and 319 controls with injuries to other body areas, who were treated in emergency rooms of five Seattle area hospitals over a one-year period. Using regression analyses to control for age, sex, education and income, accident severity, and cycling experience we found no definite effect of helmets on the risk of serious facial injury (odds ratio 0.81; 95 percent confidence interval = 0.45, 1.5), but protection against serious injuries to the upper face (odds ratio 0.27; 95% CI = 0.1, 0.8). No protection was found against serious injuries to the lower face. The independent effect of helmet use on facial injury was difficult to isolate due to the association of head and facial injuries. Our results suggest that bicycle helmets as presently designed may have some protective effect against serious upper facial injuries.     

Head injuries incurred by children and young adults during informal recreation.

To examine injuries related to playground equipment, children's vehicles, roller skates, and skateboards, 1991 data on emergency room patients younger than 25 years in the Consumer Product Safety Commission's 91 surveillance hospitals were used. Head injury was the primary diagnosis for an estimated 58,480 patients, exceeding the total number of head injuries to bicyclists younger than 25 years. The head injury rate decreased with age. The large number and high rate of head injuries in children involved in a variety of recreational activities suggests the value of multipurpose helmets.     

Bicycle helmet use by adults: the impact of companionship.

Most of the nearly 1,000 fatal bicycle-related injuries annually could be prevented if riders used safety helmets. Helmet use by adult bicyclists has received relatively little attention because educational campaigns to promote helmet use generally focus on children. Helmet use by adult and child bicyclists at 120 suburban and rural sites in three Maryland counties was observed on two Saturdays in 1990-91 during an evaluation of the impact of a mandatory helmet law. Concordance or discordance of helmet use within various groups of bicyclists--adults only, adults with children, and children only--was recorded. Helmet use among 2,068 adult bicyclists was 49 percent, 51 percent, and 74 percent in the three counties. In two counties combined, 52 percent (365 of 706) of solo adult bicyclists wore helmets compared with only 5 percent (5 of 94) of solo child bicyclists (P < .001). Helmet use or nonuse was concordant among 87 percent of 277 adult-adult pairs, 94 percent of 50 child-child pairs, and 91 percent of 32 adult-child pairs of bicyclists observed. Concordance rates of helmet use or nonuse were similarly high among pairs of adult bicyclists of the same or mixed sexes. These data are consistent with the concept that both adults and children tend to adopt the helmet-wearing behaviors of their companions. Public health efforts focused on adults should encourage helmet use by adult bicyclists both to prevent head injuries and to provide a role model for children.     

A decrease in both mild and severe bicycle-related head injuries in helmet wearing ages--trend analyses in Sweden

Several international studies point at the efficacy of bicycle helmets in reducing head injuries. In Sweden, observational studies show that from 1988 to 1996 helmet use increased in all categories of cyclists. The objectives of this study were to analyse the trends of bicycle-related head injuries based on their main diagnosis and external cause of injury by different age groups. Our study area was the whole population of Sweden from 1987 to 1996. Outcome evaluation was based on data from the Swedish National Hospital Discharge Register concerning all bicycle-related injuries from 1987 to 1996, which presented 49 758 reported in-patient care. The trends in incidence rates (IRs) were studied with regression analyses. The results show that children under 15 years had the highest IRs. For these children, the IR decreased by 46%. The head injuries in children decreased both in collisions with motor vehicles and in other accidents. Similarly, the IR of concussion and skull fracture decreased. For non-head injuries, there were no significant changes for children. On the other hand, the incidence of both head and other injuries for adults aged 16-50 years increased. Ages above that showed no significant changes. Our conclusions are that the decrease in IR for bicycle-related head injuries refers to children in ages for whom bicycle helmet use during the period increased. This could not be explained by any general decrease in bicycle-related accidents or by any changes in the distribution of injuries after collision with motor vehicles. The increasing helmet use among younger schoolchildren probably contributed to the decrease in head injuries.     

Age gradient in the cost-effectiveness of bicycle helmets

OBJECTIVES: This study analyzed the reduction in risk of head injuries associated with use of bicycle helmets among persons ages 3 to 70 and the cost-effectiveness of helmet use based on this estimated risk reduction. METHODS: To derive our cost-effectiveness estimates, we combined injury incidence data gathered through a detailed and comprehensive injury registration system in Norway, acute medical treatment cost information for the Norwegian health service, and information reported in the scientific literature regarding the health protective effects of helmet use. The analysis included all cases of head injuries reported through the registration system from 1990 through 1996. We performed an age-stratified analysis to determine the incidence of bicycle-related head injuries, the 5-year reduction in absolute risk of injury, the number needed to treat, and the cost-effectiveness of helmet use. To test the robustness of the findings to parameter assumptions, we performed sensitivity analysis. RESULTS: The risk of head injury was highest among children aged 5 to 16. The greatest reduction in absolute risk of head injury, 1.0 to 1.4% over 5 years estimated helmet lifetime, occurred among children who started using a helmet between the ages of 3 and 13. Estimates indicate that it would cost approximately U.S. $2,200 in bicycle helmet expenses to prevent any one upper head injury in children ages 3-13. In contrast, it would cost U.S. $10,000-25,000 to avoid a single injury among adults. CONCLUSIONS: Bicycle safety helmets appear to be several times more cost-effective for children than adults, primarily because of the higher risk of head injury among children. Programs aiming to increase helmet use should consider the differences in injury risk and cost-effectiveness among different age groups and target their efforts accordingly.     

Barriers to bicycle helmet use among Dutch paediatricians

Background In the Netherlands, bicycle helmet wearing rates are very low and perceived social barriers to helmet use are important. We aimed to determine why Dutch paediatricians do or do not wear helmets while bicycling and whether their personal behaviour is influencing their position about the promotion of helmet use. Methods Attendants to the annual meeting of the Dutch Paediatric Society (7–9 November 2006) were surveyed about bicycle riding frequency, helmet use, reasons for not wearing a helmet, helmet use among their own children and personal position about the promotion and legislation of bicycle helmet use. Results Of the 1110 paediatricians who are active in the Netherlands, 258 answered the survey. Ninety‐six per cent of the respondents ride a bicycle (68% more than once a week). Bicycle was used as a mean of transport (32%), as a recreation/sport (11%) or with both purposes (57%). When cycling for transportation, 94% never wear a helmet and 2% always wear it. When cycling for recreation, 70% never wear a helmet and 18% always wear it. The most common reasons given for not wearing a helmet were: ‘I never thought about that’ (43%), ‘Poor appearance’ (31%), ‘Nobody uses it in the Netherlands’ (27%) and ‘Uncomfortable’ (25%). A majority (91%) of the respondents agreed that bicycle helmets are effective in reducing the rate of head injury to bicyclists and that they should be advised to children (82%) and adolescents (54%). Conclusions Our results indicate that among Dutch paediatricians, cycling rate is high and helmet wearing rate is very low and that they experience numerous personal barriers to bicycle helmet use. This might explain why bicycle helmet promotion campaigns are scarcely supported by Dutch paediatricians.     

Public Bicycle Share Programs and Head Injuries

Objectives. We evaluated the effect of North American public bicycle share programs (PBSPs), which typically do not offer helmets with rentals, on the occurrence of bicycle-related head injuries.Methods. We analyzed trauma center data for bicycle-related injuries from 5 cities with PBSPs and 5 comparison cities. We used logistic regression models to compare the odds that admission for a bicycle-related injury would involve a head injury 24 months before PBSP implementation and 12 months afterward.Results. In PBSP cities, the proportion of head injuries among bicycle-related injuries increased from 42.3% before PBSP implementation to 50.1% after (P < .01). This proportion in comparison cities remained similar before (38.2%) and after (35.9%) implementation (P = .23). Odds ratios for head injury were 1.30 (95% confidence interval = 1.13, 1.67) in PBSP cities and 0.94 (95% confidence interval = 0.79, 1.11) in control cities (adjusted for age and city) when we compared the period after implementation to the period before.Conclusions. Results suggest that steps should be taken to make helmets available with PBSPs. Helmet availability should be incorporated into PBSP planning and funding, not considered an afterthought following implementation.In the past decade, public bicycle share programs (PBSPs) have become increasingly common in North American cities.1 Often implemented by government agencies, either independently or through a public–private partnership, these networks of bicycles are available for shared use to individuals at some nominal cost relative to the duration of the rental. Such programs are commonly referred to as BIXI programs in Canada (Bicycle-Taxi), and programs in the United States include B-cycle, DecoBike, and CaBi (Capitol Bikeshare in Washington, DC).Traumatic brain injuries (TBIs) account for the majority of bicycle-related deaths and one third of bicycle-related injuries.2 In 2012, an estimated 81 909 bicycle-related head injuries were treated in US emergency departments.3 Bicycle helmets have been shown to reduce the risk of head, brain, and severe brain injury by 63% to 88%.2 Observational data suggest that fatal TBI risk increases 3-fold when an injured cyclist was not wearing a helmet.4 Educational and advocacy efforts have led to the implementation of mandatory helmet legislation for bicyclists aged younger than 18 years in many American cities and states and in several Canadian cities or provinces. Although no US statewide laws currently exist for adult bicyclists, in Canada, 4 provinces (British Columbia, New Brunswick, Nova Scotia, and Prince Edward Island) have legislation requiring helmets for bicyclists of all ages.5The popularity of PBSPs in the United States has been met with enthusiasm from the public health community because they provide cardiovascular exercise and an active lifestyle.6,7 Reduced traffic congestion and emissions are added environmental benefits.7,8 It is evident that the presence of PBSPs increases cycling activity among individuals living near available bicycles.9–11 However, PBSPs do not typically provide helmets, and in an evaluation of the barriers and facilitators to the use of a PBSP in Brisbane, Australia (where helmet use is mandatory), 61% of focus group respondents cited helmet inaccessibility or lack of desire to wear one as the main barriers to using the program.12 Accordingly, some PBSPs and cities offer courtesy helmets or free helmet giveaways,12,13 and a pilot project in the District of Columbia offers tourists loaner helmets.14 However, these efforts appear to be limited and are the exception, rather than the rule. Observational studies indicate that the majority of PBSP users do not wear helmets, and thus have significantly higher odds of riding unhelmeted than private bicycle users.9,13,15–17 Recent research in a single North American city suggests that PBSP implementation was not associated with self-reported collisions or near-misses; however, that study was underpowered and was subject to recall bias.18With more PBSPs potentially resulting in more unhelmeted bicyclists, it is possible that cities with these programs may experience an increase in bicycling-associated head injuries compared with cities with no such programs. Our objective was to assess the effect of PBSPs on the occurrence of bicycle-related head injuries.     

Bicyclists, helmets and head injuries: a rider-based study of helmet use and effectiveness.

We interviewed 516 bicyclists over age 10 regarding helmet use and head injuries. Although 19 per cent owned helmets, only 8 per cent were wearing them when interviewed. Riders wearing helmets were more highly educated and reported higher car seat belt use. Nearly 4 per cent of the bicyclists reported striking their heads in a cycling mishap during the previous 18 months; those wearing helmets at the time of the mishap were less likely to have sustained head injuries.     

H地区骑自行车者伤害的动态研究

[目的 ]分析H地区自行车伤害的发生率和死亡率及其动态变化 ,为开展伤害预防提供依据。 [方法 ]采用1994年到 1998年公安部交通管理局及部分H地区公安局的道路交通事故统计数据 ,及H地区人口统计资料进行分析。[结果 ]自行车伤害在不同交通方式伤害中居首位 ,其伤害的死亡率最高值为 2 5 82 /10万 ,是美国的 8倍多。其中至少有 61 5 %的死亡者为头部损伤 ,其中大部分 (74 6% )由头部与水泥或柏油路面碰撞引起。所有的病人无一在受伤时佩带头盔 ,而且在所有骑自行车的人群中都没有使用头盔。 [结论 ]在H地区同自行车相关的头部损伤是一个严重的公共卫生问题 ,应尽快建立自行车事故伤的监测系统 ,通过采取立法手段在公众中强制推行佩带头盔同时进行自行车安全教育干预 ,改善道路环境等措施控制自行车事故伤害     

Bicycle helmet use by children: knowledge and behavior of physicians.

A survey of pediatricians and family physicians in Tucson, Arizona revealed that the majority knew that bicycle accidents are an important cause of childhood mortality and were aware that head trauma causes most bicycle-related deaths. Ninety-two per cent knew that children rarely use bicycle helmets and most believed this was due to inadequate parental awareness of the importance of helmets. Despite this, many physicians never include bicycle safety in patient education provided during well-child care.     

Rates of bicycle helmet use in an affluent Michigan County.

Bicycle helmet use in the United States has remained low despite clear demonstration of its beneficial effect on reducing the incidence of serious head injury. Several interventions have been reported, with variable results and costs. Much of the recent literature has focused on child cyclists and on demographic factors associated with helmet use. This paper reports on helmet use by children and adults in a sample of 652 riders in an affluent southeast Michigan region, chosen to minimize the effect of previously recognized socioeconomic negative predictors that are not readily changed by intervention. Subjects were classified by age, sex, location, riding surface, type of bicycle, child bicycle seat use, child bicycle trailer use, and helmet use by companions. Overall helmet use was 24 percent; infants and toddlers had the highest rate of helmet use at 61 percent, followed by adults at 26 percent and school-aged children at 17 percent. The strongest predictor of helmet use in all age categories was the presence of a helmeted companion. Adult helmet use was also positively predicted by riding in the street and by riding a racing-type bicycle. The use of a city-type bicycle negatively predicted helmet use. For non-adults, female sex and the use of a child seat or trailer were positive predictors. Fostering peer pressure to increase helmet use may be an effective yet relatively inexpensive way to achieve the goal of widespread use of bicycle helmets.     

Unintentional injuries in the home in the United States Part I: mortality

BACKGROUND: Unintentional injuries are a leading cause of death in the United States. It is unclear, however, what proportion of these injuries occur in the home. The purpose of this paper is to quantify and describe fatal unintentional injuries that take place in the home environment. METHODS: Data from the National Vital Statistics System (NVSS) were used to calculate average annual rates for unintentional home injury deaths, with 95% confidence intervals from 1992 to 1999 for the United States overall, and by mechanism of injury, gender, and age group. RESULTS: From 1992 to 1999, an average of 18,048 unintentional home injury deaths occurred annually in the United States (6.83 deaths per 100,000). Home injury deaths varied by age and gender, with males having higher rates of home injury death than females (8.78 vs 4.97 per 100,000), and older adults (>/=70 years) having higher rates than all other age groups. Falls (2.25 per 100,000), poisoning (1.83 per 100,000), and fire/burn injuries (1.29 per 100,000) were the leading causes of home injury death. Rates of fall death were highest for older adults, poisoning deaths were highest among middle-aged adults, and fire/burn death rates were highest among children. Inhalation/suffocation and drowning deaths were important injury issues for young children. CONCLUSIONS: Unintentional injury in the home is a significant problem. Specific home injury issues include falls among older adults, poisonings among middle-aged adults, fire/burn injuries among older adults and children, and inhalation/suffocation and drowning among young children. In addition, recommendations are presented for improvements to the NVSS.     

Predicting and reinforcing children's intentions to wear protective helmets while bicycling.

The researchers undertook to identify the factors that are most likely to influence children's intentions to use bicycle helmets. To determine the most important intention influencing factors, a random sample of 797 students in grades 4 through 6 completed a self-administered questionnaire concerning their beliefs about helmet use. They were asked about their perceptions of the risk of riding bicycles unprotected, the severity of possible head injuries, and about other bicycle-safety related behaviors. Factors that best predicted the student's intentions to use bicycle helmets involved both behavioral beliefs and normative beliefs. Analysis of factors influencing those with low intentions to use helmets, compared to those with high intentions, suggests the most effective messages that health planners can provide preadolescents to influence them to use helmets. They are that helmet use is fun and attractive, helmets provide a new look and a sporting image, and friends approve of and value this behavior. Parents, and particularly mothers, can reinforce their children's intentions to use helmets and their involvement should be encouraged.