PEDIATRICS Vol. 91 No. 4 April 1993, pp. 772-777
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Evaluation of a Promotional Strategy to Increase Bicycle Helmet Use by Children

Patricia C. Parkin MD, FRCPC1, Laura J. Spence BScN2, Xiaohan Hu MB, MPH, PhD3, Katherine E. Kranz BAAN2, Linda G. Shortt BScN, MEd4, and David E. Wesson MD, FRCSC5

1 From the Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada and The Hospital for Sick Children/Kiwanis Injury Prevention and Research Program, Ontario, Canada
2 The Hospital for Sick Children/Kiwanis Injury Prevention and Research Program, Ontario, Canada
3 From the Department of Preventive Medicine and Biostatistics, University of Toronto and The Hospital for Sick Children/Kiwanis Injury Prevention and Research Program, Ontario, Canada
4 The East York Health Unit, East York, Ontario, Canada
5 From the Department of Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada and The Hospital for Sick Children/Kiwanis Injury Prevention and Research Program, Ontario, Canada

Bicycle-related head injuries are an important cause of death and disability, despite the availability of helmets. The objective of this study was to evaluate the effectiveness of a school-based bicycle helmet promotion program in increasing helmet use by children while controlling for secular trends. Two high-income and two low-income schools in an urban Canadian community were selected to receive a bicycle helmet promotion intervention, with the remaining 18 schools serving as controls. Approximately 1800 observations of bicycling children were made at randomly selected observational sites 2 to 5 months after the intervention to assess changes in behavior. Helmet use at all observation sites tripled from 3.4% (1990, preintervention) to 16% (1991, postintervention). In the high-income intervention area, observed helmet use rose dramatically from 4% to 36% in contrast to the more modest increase in the high-income control area from 4% to 15%. In the low-income intervention area, there was a modest increase from 1% to 7%, but it did not differ from the increase in the low-income control area from 3% to 13%. The program was highly successful in children of high-income families but not in children of low-income families. Developing strategies for low-income families remains a priority.

Key Words: injury prevention • bicycle helmet • head injuries • children

Submitted on September 23, 1992
Accepted on November 18, 1992




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