PEDIATRICS Vol. 96 No. 2 August 1995, pp. 283-287
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Evaluation of a Subsidy Program to Increase Bicycle Helmet Use by Children of Low-Income Families

Patricia C. Parkin MD, FRCPC1, Xiaohan Hu MB, MPH, PhD2, Laura J. Spence BScN3, Katherine E. Kranz BAAN3, Linda G. Shortt BScN, MEd4, and David E. Wesson MD, FRCSC5

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

Objective. We have previously shown that an educational program was not effective in increasing bicycle helmet use in children of low-income families. The objective of this study was to evaluate a combined educational and helmet subsidy program in the same population, while controlling for secular trends. The secondary objective was to complete a third year of surveying children's bicycle helmet use throughout the study community.

Design. A prospective, controlled, before-and-after study.

Subjects. Bicycling children 5 to 14 years of age from areas of low average family income.

Setting. A defined geographic community within a large urban Canadian city.

Intervention. In April 1992, students in three schools located in the area of lowest average family income were offered $10 helmets and an educational program; three other low-income areas served as control areas.

Main Outcome Measure. Helmet use was determined by direct observation of more than 1800 bicycling children.

Results. Nine hundred ten helmets were sold to a school population of 1415 (64%). Reported helmet ownership increased from 10% to 47%. However, observed helmet use in the low-income intervention area was no different from the rate in the three low-income control areas (18% versus 19%). There was no difference in the trend in helmet use during the period of 1990 through 1992 in the intervention area (4% to 18%) compared with the control areas (3% to 19%). Helmet use rates from all income areas have increased from 3.4% in 1990, to 16% in 1991, to 28% in 1992. In 1992, helmet use in the high-income areas was 48% and in the low-income areas was 20%.

Conclusions. There has been a trend toward increasing helmet use in all income areas during the 3-year period. Despite encouraging helmet sales and increases in reported helmet ownership, the results of the observational study do not support the efficacy of a helmet subsidy program in increasing helmet use in children residing in areas of low average family income. Strategies to increase helmet use in children of low average family income remain a priority.

Submitted on August 15, 1994
Accepted on November 7, 1994




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