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.     

Socioeconomic status and risk for substandard medical care.

OBJECTIVE--To assess whether the socioeconomic status of the patient was associated with the risk of adverse events, defined as medical injuries caused by medical management, and the proportion of these events that resulted from substandard care. SETTING--51 hospitals in New York State. METHODS--Rates of medical injury and substandard care by gender, race, income, and payer status were developed from reviews of 30,195 medical records in New York in 1984. We evaluated these socioeconomic parameters in a multivariate analysis, while controlling for hospital-level factors. RESULTS--We found that uninsured patients (odds ratio, 2.35; 95% confidence interval, 1.40 to 3.95) were at greater risk for substandard care. The characteristics of the hospitals to which patients were admitted did not affect this result. Race, gender, and income were not independently associated with risk for medical injury or substandard care in multivariate analyses. CONCLUSION--Our findings suggest that the uninsured are at greater risk for suffering medical injury due to substandard medical care.