Child bicycle helmet promotion programs

Evidence Rating  
Evidence rating: Scientifically Supported

Strategies with this rating are most likely to make a difference. These strategies have been tested in many robust studies with consistently positive results.

Health Factors  
Date last updated

Programs that promote bicycle helmet use for children include bicycle safety education for children and parents, media campaigns, or free or subsidized helmet distribution. Such programs are delivered in school, community, or health care settings1. Respondents to a national 2012 survey of bicyclists reported that 45% of children always wear a helmet, and 18% never wear a helmet2

What could this strategy improve?

Expected Benefits

Our evidence rating is based on the likelihood of achieving these outcomes:

  • Increased helmet use

  • Reduced fatal and non-fatal injuries

Potential Benefits

Our evidence rating is not based on these outcomes, but these benefits may also be possible:

  • Reduced health care costs

What does the research say about effectiveness?

There is strong evidence that helmet promotion programs increase children’s likelihood of wearing helmets while bicycling1, 3, 4. Wearing a helmet can reduce fatal and non-fatal head and face injuries for bicyclists5.

Programs targeted at children under age 12 can increase helmet wearing more than programs for children of all ages1. Both community- and school-based programs appear to increase helmet wearing; however, community-based programs may increase helmet wearing more than school-based programs1. Programs that give helmets away appear to increase helmet wearing more than programs that subsidize helmets or offer education only1, 3.

Children from low income families appear to use helmets less than their higher income counterparts. A UK-based study suggests that providing free helmets and school-based education to children in low income neighborhoods can reduce inequalities in helmet ownership1.

Some bicycle safety educational programs can also increase children’s knowledge and practice of how to wear helmets correctly6, 7, 8; correct helmet wearing maximizes protection against head injury and fatality7.

Researchers estimate that helmets save 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 insure9.

How could this strategy impact health disparities? This strategy is rated likely to decrease disparities.
Implementation Examples

There are many bicycle helmet promotion programs in the United States. The North Carolina Department of Transportation, for example, provides free helmets to low income children through its Bicycle Helmet Initiative10. The American Brain Foundation and American Academy of Neurology also hold a free helmet giveaway event in Minneapolis annually11.

Implementation Resources

BHSI - Bicycle Helmet Safety Institute (BHSI).

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

SKW-Bike safety - Safe Kids Worldwide (SKW). Safety tips: Bike.

Bikeleague-Helmet - The League of American Bicyclists (Bikeleague). Bike helmets.


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1 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.

2 NHTSA-Schroeder 2013 - Schroeder P, Wilbur M. 2012 National survey of bicyclist and pedestrian attitudes and behavior, volume 2: Findings report (Report No. DOT HS 811 841 B). Washington, D.C.: National Highway Traffic Safety Administration (NHTSA); 2013.

3 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.

4 CG-Health communication - The Guide to Community Preventive Services (The Community Guide). Health communication and social marketing: Campaigns that include mass media and health-related product distribution.

5 Olivier 2017 - Olivier J, Creighton P. Bicycle injuries and helmet use: a systematic review and meta-analysis. International Journal of Epidemiology. 2016;46(1):278-292.

6 McLaughlin 2010 - McLaughlin KA, Glang A. The effectiveness of a bicycle safety program for improving safety-related knowledge and behavior in young elementary students. Journal of Pediatric Psychology. 2010;35(4):343-353.

7 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.

8 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.

9 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.

10 NCDOT-BHI - North Carolina Department of Transportation (NCDOT). Bicycle helmet initiative (BHI).

11 AAN-Helmet giveaway - American Academy of Neurology (AAN). Protect your brain: Free bike helmet giveaway in Minneapolis.