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Child bicycle helmet promotion programs

Evidence Rating

Scientifically Supported

Health Factors

Bicycle helmet promotion programs may include health education, media campaigns, or free or subsidized helmets (). Respondents to a national 2012 survey reported that 45% of children always wear a helmet, and 18% never wear a helmet (NHTSA-Schroeder 2013). Helmets offer protection for bicyclists and bike passengers (Uibel 2012).

Expected Beneficial Outcomes (Rated)

  • Increased helmet use

Other Potential Beneficial Outcomes

  • Reduced fatal and non-fatal injuries

  • Reduced health care costs

Evidence of Effectiveness

There is strong evidence that helmet promotion programs increase children’s likelihood of wearing helmets while bicycling (, ). Some educational programs can also teach children how to wear helmets correctly (Uibel 2012, Cusimano 2013, ); correct helmet wearing maximizes protection against head injury and fatality (Cusimano 2013).

Programs targeted at children under age 12 can increase helmet wearing more than programs for children of all ages (). Community-, school-, and health care- based programs appear to increase helmet wearing; community-based programs may increase helmet wearing more than school-based programs (). Programs that give helmets away appear to increase helmet wearing more than programs that subsidize helmets or offer education only (, ). 

Low income children appear to use helmets less than their wealthier counterparts. One program in a disadvantaged neighborhood appeared to reduce inequalities in helmet ownership ().

Children’s helmets purchased in bulk generally cost programs $10 to $13 per helmet. Researchers estimate that each helmet saves an average of $440 over five years in medical and insurance costs. One analysis suggests that HMOs offering a children’s helmet subsidy would save money if helmet use reached 50% among those they insure ().

Impact on Disparities

Likely to decrease disparities

Implementation Examples

There are many bicycle helmet promotion programs in the United States.

Implementation Resources

BHSI - Bicycle Helmet Safety Institute (BHSI).

PBIC-Helmet - Pedestrian and Bicycle Information Center (PBIC). Helmet guidelines.

Citations - Evidence

* Journal subscription may be required for access.

Miller 2000* - Miller TR, Levy DT. Cost-outcome analysis in injury prevention and control: Eighty-four recent estimates for the United States. Medical Care. 2000;38(6):562-82.

Cochrane-Owen 2011* - Owen R, Kendrick D, Mulvaney C, Coleman T, Royal S. Non-legislative interventions for the promotion of cycle helmet wearing by children. Cochrane Database Systematic Reviews. 2011;(11):CD003985.

Uibel 2012 - Uibel S, Müller D, Klingelhoefer D, Groneberg DA. Bicycle helmet use and non-use - recently published research. Journal of Occupational Medicine and Toxicology. 2012;7:9.

Nauta 2014* - Nauta J, van Mechelen W, Otten RHJ, Verhagen EAL. A systematic review on the effectiveness of school and community-based injury prevention programmes on risk behaviour and injury risk in 8-12 year old children. Journal of Science and Medicine in Sport. 2014;17(2):165–72.

Cusimano 2013 - Cusimano MD, Faress A, Luong WP, et al. Evaluation of a bicycle helmet safety program for children. Canadian Journal of Neurological Sciences. 2013;40(5):710–6.

Hooshmand 2014* - Hooshmand J, Hotz G, Neilson V, Chandler L. BikeSafe: Evaluating a bicycle safety program for middle school aged children. Accident Analysis and Prevention. 2014;66:182–6.

Date Last Updated

Mar 3, 2015