Bicycle Helmet Use Among Maryland Children: Effect of Legislation and Education
1 From the Division of Epidemiology and Disease Control, Maryland Department of Health and Mental Hygiene, Baltimore, MD and From the Division of Field Epidemiology, Epidemiology Program Office, Centers for Disease Control, Atlanta, GA
2 From the Division of Injury Control, National Center for Environmental Health and Injury Control, Centers for Disease Control, Atlanta, GA
3 From the Division of Injury Prevention and Rehabilitation Information, Maryland Department of Health and Mental Hygiene, Baltimore, MD
4 Injury Prevention Center, The Johns Hopkins University School of Hygiene and Public Health, Baltimore, MD
5 From the Howard County Health Department, Columbia, MD
Although bicycle helmets are effective in preventing head injuries, use of helmets among children remains infrequent. In response to the bicycling deaths of two children, Howard County, Maryland, became the first US jurisdiction to mandate use of bicycle helmets for children. Schoolchildren were lectured by police about the law before its enactment. Prelaw and postlaw helmet use was observed in Howard County and two control counties: Montgomery (which sponsored a community education program) and Baltimore County (nohelmet activities). Prelaw crude helmet use rates for children were 4% (95% confidence interval [CI] 0% to 10%) for Howard, 8% (95% CI 3% to 13%) for Montgomery, and 19% (95% CI 5% to 33%) for Baltimore. Postlaw rates were 47% (95% CI 32% to 62%), 19% (95% CI 11% to 27%), and 4% (95% CI 0 to 11%), respectively. The rate of bicycle helmet use by Howard County children is now the highest documented for US children. A similar increase in helmet use among children younger than 16 years nationwide could prevent about 100 deaths and 56 000 emergency-department-treated head injuries annually. Physicians and other health professionals should consider proposing and supporting the Howard County approach in their communities.
Key Words: bicycle helmets • injury prevention • legislation • education
Submitted on November 1, 1991
Accepted on January 28, 1992
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